• Coronary Bypass Surgery

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    Coronary artery bypass graft surgery is a type of open-heart surgery used to treat one or more dangerous blockages in the heart arteries. If you have been recommended for, or have undergone, the surgery, it is because blockages in your heart arteries have been found to be restricting the flow of oxygenated blood to the heart. These blockages can cause symptoms such as chest pain (angina), fatigue, shortness of breath, and nausea, among others. These blockages can also cause a heart attack or other damage to the heart muscle.

    It is likely that you have a family member, friend, or coworker who has had bypass surgery. According to the U.S. Centers for Disease Control and Prevention, 395,000 coronary artery bypass graft surgeries were performed in 2010. The surgery has been performed for over 50 years, and is a well-proven treatment for serious heart disease.

    Read on for more about the disease process that can make bypass surgery necessary and for how bypass surgery is performed.

    Treating Coronary Artery Disease

    What Do the Different terms for Bypass Surgery Mean?

    You may hear bypass surgery referred to by different names. Coronary artery bypass graft surgery, or CABG (pronounced “cabbage”), is one common term. This term accurately describes exactly what the surgery accomplishes:  grafting (or sewing) a new blood vessel to a heart artery to re-route blood flow around a blockage. You will also hear CABG referred to simply as bypass surgery, and you have probably heard the term open-heart surgery. That is because the procedure is an open-chest operation, where the heart surgeon makes an incision in the chest, opens the sternum (or breastbone), and makes an incision in a membrane around the heart to expose the heart for the procedure. You have also probably heard the terms double or triple bypass or even quadruple or quintuple bypass. These terms refer to the number of heart arteries that needed to be bypassed with grafts.

    Coronary artery bypass graft surgery treats hearts with coronary artery disease,in which fatty deposits build up in the coronary (heart) arteries, restricting blood flow to the heart and potentially leading to chest pain, or angina,. These deposits, or plaques, can also be vulnerable to rupturing. When a plaque ruptures, a blood clot can form at the site of the rupture, cutting off blood flow to the heart and causing a heart attack.

    Think of a highway bypass that allows you to drive around traffic congestion in a city. Or a detour that takes you around a road that is obstructed and needing repair. The bypass or detour takes you from the normal road, goes around the blockage, and then brings you back to the smooth road. Bypass surgery takes blood flow around and away from the diseased portion of the blood vessel, and re-routes it to the healthy part of the vessel. The new blood vessel allows blood to bypass the diseased, clogged artery and travel freely to the heart.

    During bypass surgery, a heart surgeon removes a blood vessel from one of several sites in the body to use as the bypass graft. The most successful bypasses use the internal mammary artery – the artery that runs just inside the edge of each side of the breastbone. During bypass surgery, the end of this blood vessel is removed from the chest wall to be used to attach to the heart beyond the blockage.

    The beginning of the internal mammary artery is left in place, which is the artery beneath the collarbone. In this way, blood flowing in the normal route up toward the collarbone flows down the internal mammary artery normally, except now it is joined to the coronary artery of the heart. Like the road detour, it has bypassed the obstruction.

    The surgeon may also remove a segment of blood vessel from the leg (saphenous vein) or wrist (radial artery). The surgeon then attaches this new blood vessel (the graft) to the aorta (the major artery originating from the heart). The other end of the graft is then attached to the coronary artery below the blockage that is being treated. The graft allows blood to flow from the aorta, down the graft to bypass the blockage, and restore flow to the heart muscle.

    Coronary artery bypass graft surgery can save your life or that of a loved one, and it can improve your quality of life. If you are about to have bypass surgery or are recovering now, you probably have many questions about the procedure and the practical aspects of getting back to daily life. Learning more about the surgery can put your mind at ease and help you manage stress to move forward for a positive recovery.

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  • More About Bypass Surgery

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    About Your Coronary Bypass Surgery

    Coronary artery bypass graft surgery is an operation used to treat blockages in the arteries that supply the heart muscle with oxygen-rich blood. When a heart artery is blocked, it can cause chest pain or discomfort and other unpleasant symptoms, such as shortness of breath, fatigue, nausea, or dizziness. A blocked artery can also cause a heart attack.

    Benefits and Risks of Coronary Bypass Surgery

    Coronary artery bypass graft surgery is one of several major advances in the effort to manage cardiovascular disease - the leading cause of death and disability in the United States. You may have heard this surgery referred to simply as “bypass surgery” or as CABG (pronounced “cabbage” and short for “coronary artery bypass graft”).

    Evolution and Types of Coronary Bypass Surgery

    Coronary artery bypass graft surgery has been performed as a treatment for blocked heart arteries for almost 50 years. Its development marked a revolution in heart attack treatment. Prior to the existence of coronary bypass surgery, most heart attack patients were put on bed rest for weeks, and survival rates were low. In the decades since, the surgery has evolved to keep pace with new discoveries in medical research.

    Incision Care After Coronary Bypass Surgery

    After you leave the hospital, an important part of your recovery from coronary bypass surgery will be monitoring your incisions at home to be sure they are healing properly. You will probably have a long incision down the center of your chest. If your coronary bypass surgery was a minimally invasive operation, you may have a smaller incision, or series of incisions, in between your ribs. You may also have a long incision or smaller puncture sites in your leg if saphenous vein was used for the graft.

    Long-Term Recovery and Support After Coronary Bypass Surgery

    If you had coronary artery bypass graft surgery, the life-threatening or severe blockages in your heart arteries have been corrected, but the work of improving your cardiovascularhealth is far from over. The blockages in your arteries were caused by an underlying, progressive disease process in which a fatty, waxy substance called plaque builds up on the artery walls and restricts blood flow.

    Questions to Ask Your Doctor About Coronary Bypass Surgery

    Use the following questions as a tool to help you talk to your physician about coronary artery bypass graft surgery.

    Resources on Coronary Artery Bypass Graft Surgery

    The links below may help you as you seek to understand coronary bypass surgery and the underlying disease process that the surgery treats. Mended Hearts and WomenHeart are patient support groups that can connect you with others who have experienced coronary bypass surgery.

    What to Expect Before Coronary Bypass Surgery

    If you and your cardiac surgeon have decided together that elective (non-emergency) coronary bypass surgery is the best treatment for your heart disease, there are certain preparations that you will make in coordination with your care team. These preparations may include diagnostic tests, dietary and medication restrictions, exercise restrictions, and gathering of any personal items you will need during your stay at the hospital. You will want to have a plan in place for how you will get to the hospital and how you will return home and be cared for when your hospital stay is complete.

    What to Expect During Coronary Bypass Surgery

    The information below describes traditional coronary artery bypass graft surgery, which uses a heart-lung bypass machine to allow the surgeon to perform the procedure on a still heart. For more on minimally invasive procedures with smaller incisions or without the use of a heart-lung bypass machine, click here.

    What to Expect Immediately After Coronary Bypass Surgery

    As a coronary artery bypass graft surgery patient, you have just undergone major surgery. Even though specific problems in your heart have been addressed, your body has been through a lot, and you will need time to recover and regain your strength. Everyone’s recovery is unique.

    Who Should Be Treated with Coronary Bypass Surgery?

    Treatment for coronary artery disease - the disease process that causes blockages in your heart arteries - is not one-size-fits-all. Your healthcare team will evaluate the extent and location of blockages in your heart arteries, as well as your overall health, before making recommendations about the best heart disease treatment for you.

    Your Care Team During Coronary Bypass Surgery

    If treating your blockages requires bypass surgery, your cardiologist will refer you to a cardiac surgeon, or cardiothoracic surgeon. These surgeons specialize in treatment of the heart, lungs, esophagus, and chest.