Heart Bypass FAQ

From the WebMD Archives

Sept. 7, 2004 -- Former President Bill Clinton is recovering from heart bypass surgery, one of the most common types of major surgery in the U.S. How much do you know about it?

What is heart bypass surgery?

Arteries carry blood from the heart to the rest of the body. But sometimes arteries become blocked. When this happens, surgeons create a new channel to bypass the blockage. Doctors call it bypass graft surgery. It uses a working blood vessel from another part of the body -- the graft -- to channel blood around the blocked area.

When is bypass surgery needed?

The aorta is the main artery that carries blood from the heart. Two main blood vessels branch from the base of it: the right and left coronary arteries. Each of the coronary arteries has many branches.

When plaque buildup narrows an artery to about 70% of its normal size, the artery is essentially blocked. Less severe blockage can be relieved by angioplasty and stenting. That's when a tiny balloon is threaded into the blocked artery and slowly inflated. Then a tube called a stent is used to keep the artery open.

But severe blockage usually requires bypass surgery.

What is multiple bypass surgery?

Sometimes several arteries are blocked, and several bypasses are needed. If, for example, there were blockages in all three coronary arteries and one branch, a person would get four bypasses. This is called quadruple bypass surgery.

People who need several bypasses aren't necessarily at higher risk than those who need just one, says UCLA professor Prediman K. Shah, MD, director of cardiology and the Atherosclerosis Research Center at Cedars-Sinai Medical Center in Los Angeles.

"It is not the number of bypasses that dictates a patient's risk," Shah tells WebMD. "The risk is more dependent on the general condition of the patient, whether the patient has other conditions, such as kidney disease or diabetes, and the condition of the heart muscle itself. So if the patient's condition is good, the number of bypasses may mean a longer surgery but not significantly greater risk."


How is bypass surgery done?

Doctors take a substitute blood vessel from another part of the body. It's safe to do this because the body has other ways of getting blood to areas.

The surgeon then attaches one end of the graft to the aorta and the other end to the coronary artery below the blockage.

The traditional operation calls for a six- to eight-inch cut down the center of the breastbone so the surgeon can get directly at the heart. During the operation, the body is connected to a heart-lung bypass machine that keeps the blood flowing. The heart is stopped while the doctor operates. Then the surgeon uses special wires to close the chest.

Sometimes it's possible for the surgeon to use minimally invasive surgical techniques. In this case, the incision is much smaller. And in some cases, the heart does not even have to be stopped. However, these techniques can't be used for all bypass surgeries.

How risky is bypass surgery?

In a relatively young patient -- such as former President Clinton -- who has no underlying diseases such as diabetes, the risk of bypass surgery is small.

"In skilled hands, the surgery can be carried out with overall risk of 1% to 2% of anything untoward happening," Shah says. "This varies according to age, how badly damaged the heart is, whether the aorta itself has plaque buildup -- a number of factors. But I think driving a car every day is more dangerous."

How long does it take to recover?

Once the bypass surgery is completed, doctors start the heart again with electric shocks and turn off the heart-lung machine.

The patient will have wires to monitor the heart pace and a tube to drain fluids leading from the chest. Sometimes a temporary pacemaker is attached to the wires and to the chest.

After surgery, the patient goes to an intensive care unit for a day or two of close monitoring. Then the patient is transferred to the nursing unit for three to five days.

Recovery from bypass surgery can be surprisingly rapid.

"With uncomplicated surgery in a person of President Clinton's age -- if his heart muscle is not damaged -- you can be out of the hospital in five days," Shah says. "If they say he has an excellent chance of full recovery, he would be an excellent candidate for fast recovery. I would say he has only a 1% to 1.5% risk of anything bad happening."


Once a person who has had bypass surgery leaves the hospital, home recovery means progressively increasing activity over the next two to four weeks.

"Most patients are fully functional in six to eight weeks, although some people may take longer," Shah says. "But four to six weeks of progressive recuperation at home is needed. The patient is not bed-bound but not leaving home. And there can be fatigue, heart arrhythmias, fluid buildup, depression. But most people recover fairly quickly."

How unusual is Clinton's condition?

Unfortunately, many American men have some degree of heart disease by the age of 50.

"The average male in the U.S., consuming a regular American diet, by age 50 has a good chance of having this disease," Shah says. "It is the norm rather than the exception. And it is largely a lifestyle issue, meaning it is avoidable."
Heart disease is also the No. 1 killer in women. Like in men, women's arteries tend to begin to clog early in life especially in those eating the typical American high-saturated fat diet. Heart disease is most likely to rear its ugly head after a woman reaches menopause.

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SOURCES: WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Heart Failure: Treating Heart Disease: Coronary Artery Bypass Surgery." Prediman K. Shah, MD, director of cardiology and the Atherosclerosis Research Center, Cedars-Sinai Medical Center, Los Angeles; professor of medicine, University of California, Los Angeles.

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