Coronary bypass surgery is a type of surgery that improves blood flow to the heart.
It is performed for people with severe coronary heart disease, also called coronary artery disease.
Coronary artery disease is a condition in which a substance called plaque builds up inside the coronary arteries.
These arteries supply the heart with oxygen-rich blood.
Plaque (an invisible layer that surrounds the arteries) is made up of fat, cholesterol, calcium, and other substances found in the blood.
Plaque buildup can narrow or block the coronary arteries and reduce blood flow to the heart muscle.
If the blockage is severe, angina (chest pain or discomfort), shortness of breath, and, in some cases, a heart attack can occur.
Coronary bypass grafting (CABG) is a treatment for coronary artery disease.
During coronary bypass surgery, a healthy artery or vein from the body is connected to the blocked coronary artery.
The artery or vein wraps around the blocked part of the coronary artery.
This creates a new passage, and oxygen-rich blood is routed around the blocked artery to the heart muscle.
Coronary bypass surgery allows up to four major blocked coronary arteries to be rerouted during a single operation.
Overview of coronary bypass surgery
Coronary bypass grafting is the most common type of open-heart surgery performed by heart surgeons.
Other names for coronary bypass grafting include:
- Open heart surgery
- Coronary bypass surgery
- Coronary artery bypass surgery
- Heart bypass surgery
Coronary artery disease is not always treated with coronary bypass.
Many people with coronary heart disease can be treated in other ways, such as lifestyle changes, medications, and a procedure called catheterization.
During catheterization, a small mesh tube called a stent may be placed in the artery to help keep it open.
Coronary bypass surgery or catheterization may be a good option if you have severe blockages in your large coronary arteries, especially if your heart’s blood pumping is already impaired.
Coronary bypass may also be an option if you have a blockage in your heart arteries that can’t be treated with a catheter.
In this case, coronary bypass is more effective than other types of treatment.
Benefits of coronary bypass surgery
If you are a candidate for coronary bypass surgery, the goals of the surgery include:
- Improve your quality of life and reduce angina and other coronary heart disease symptoms.
- Allow you to resume a more active lifestyle.
- Improve your heart’s pumping action if it’s damaged from a heart attack.
- Reduce the risk of a heart attack (in some patients, such as those with diabetes).
- Increase your chance of survival.
You may need repeat coronary bypass surgery if the grafted arteries or veins become blocked, or if new blockages appear in arteries that weren’t blocked before.
Taking medications as prescribed and making lifestyle changes as recommended by your doctor can reduce the chance of clogged arteries after coronary bypass surgery.
The results are usually excellent for the right people for the surgery.
After coronary bypass, 85 percent of people had significantly fewer symptoms, a lower risk of future heart attacks, and a significantly lower death rate within 10 years.
Types of coronary bypass surgery
Arterial grafts
The internal mammary artery is the most commonly used bypass graft.
The goal is to use these arteries for every patient who undergoes CABG.
Bypass results in the best long-term outcomes.
Inside the chest, there are two arteries on the left and right sides of the sternum. If these arteries are used in bypass surgery, they can usually be kept intact at their origin, as they have the ability to supply the heart with a good amount of oxygen.
The other end is cut and sewn into the coronary artery below the site of the blockage.
If the artery needs to be completely removed, it is called a “free” artery.
The radial (arm) artery is another common type of arterial coronary bypass.
The radial artery delivers blood to the arm (due to the presence of another artery), so most people do not experience any side effects if the radial artery is used as a graft.
If your surgeon decides to use the radial artery for coronary bypass, you will undergo tests before and during surgery to make sure this is the best option for you.
If the radial artery is used as a graft during coronary bypass, you may need to take a calcium channel blocker medication for several months after surgery.
This medication helps keep the artery open.
Some people who have radial artery coronary bypass grafting experience numbness in the wrist after surgery, but this sensation usually goes away.
This type of coronary bypass is known to have good results, although the long-term results are not fully known.
Less common arteries used for coronary bypass are the gastric artery, an artery that feeds the stomach, and the inferior artery that leads to the abdominal wall.
These arteries are difficult to use but can be a good option if other arteries can’t be used.
Vein grafting
Saphenous veins are veins in your legs that can be used as side roads.
Minimally invasive saphenous vein removal doesn’t require a long incision.
Instead, two incisions are made in the knee and a small incision is made in the groin.
This type of removal results in fewer incisions and faster healing than traditional surgery.
Although much has been done to improve the outcomes of vein grafts, they still fail in the long term.
What is the best type of coronary bypass for me?
Your surgeon will determine which type of coronary bypass is right for you. The choice depends on many factors, including the location and size of the blockage, the size of your coronary arteries, the availability of arteries and veins, your age, and other medical conditions you have.
Who are the candidates for coronary bypass?
Coronary bypass is used to treat people with severe coronary heart disease that can lead to a heart attack.
Coronary bypass can also be used to treat people with blocked arteries after a heart attack.
Your doctor may recommend coronary bypass surgery if other treatments, such as lifestyle changes or medications, don’t work.
Coronary bypass surgery may also be recommended if you have severe blockages in the large coronary arteries that supply blood to much of the heart muscle—especially if your heart’s pumping has already weakened.
Coronary bypass may also be a treatment option if you have a blockage in your heart that can’t be treated with catheterization.
Your doctor will decide whether you’re a candidate for coronary bypass surgery based on a number of factors, including:
- Severity of coronary artery disease symptoms
- The severity and location of the blockage in the coronary arteries
- Your response to other treatments
- How you live your life
- Any other medical issues you have
Coronary bypass can be performed on an emergency basis, such as during a heart attack.
Physical examination and diagnostic tests
To determine if you’re a candidate for CABG, your doctor will perform a physical exam.
He or she will examine your cardiovascular system, focusing on your heart, lungs, and pulse.
Your doctor will also ask you about any symptoms you have, such as chest pain or shortness of breath.
He or she will ask how often, for how long, and how severe your symptoms are.
Tests will be done to see which arteries are blocked, how far they are blocked, and whether there is any damage to the heart.
ECG
An electrocardiogram is a simple test that detects and records the electrical activity of your heart.
This test is used to help detect and identify the source of heart issues.
An electrocardiogram (ECG) shows how fast your heart beats and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through each part of your heart.
Stress test
Some heart conditions are easier to diagnose when your heart is working hard and beating fast.
During a stress test, you exercise (or are given medication if you are unable to exercise) to make your heart work harder and beat faster during cardiac tests.
These tests may include nuclear cardiac scans, echocardiography, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans of the heart.
Echocardiography
An echocardiogram uses sound waves to create a moving image of your heart. The test provides information about the size and shape of your heart and how well your heart chambers and valves are working.
The test can also identify areas of poor blood flow to the heart, areas of the heart muscle that don’t contract normally, and previous injury to the heart muscle due to poor blood flow.
There are several types of echocardiography, including stress echocardiography.
This test is performed before and after a stress test.
A stress echo is usually done to see if you have reduced blood flow to your heart, a sign of coronary artery disease.
Coronary angiography
Coronary angiography uses a special dye and X-rays to show the anatomy of the coronary (heart) arteries.
During the test, a long, thin, flexible tube called a catheter is placed in a blood vessel in your arm, thigh (groin) or neck.
The tube is then inserted into the coronary arteries, and the dye is injected into the bloodstream. Special X-rays are taken as the dye flows through the coronary arteries.
The dye allows your doctor to study the flow of blood through your heart and blood vessels.
This helps your doctor find obstructions that could cause a heart attack.
Other considerations for coronary bypass surgery
When determining whether you’re a candidate for coronary bypass, your doctor will also take into account:
- History and previous treatment of heart disease, including surgeries, procedures, and medications
- History of other diseases and conditions
- Age and general health
- Family history of coronary heart disease, heart attack, or other heart disease
Medications and other medical procedures can be tried before coronary bypass.
Drugs that lower cholesterol and blood pressure levels and improve blood flow through the coronary arteries are often tried.
Catheterization may also be tried before considering coronary bypass.
During this procedure, a thin tube with a balloon or other device at the end is threaded through a blood vessel into a narrowed or blocked coronary artery.
Once in place, the balloon is inflated to push the plaque aside against the artery wall.
This widens the artery and restores blood flow.
Often, a small mesh tube called a stent is placed in the artery to keep it open after the procedure.
What to expect before coronary bypass surgery
Tests can be done to prepare you for coronary bypass.
For example, you may undergo blood tests, an electrocardiogram, an echocardiogram, a chest X-ray, a cardiac catheterization, and a coronary angiography.
Your doctor will give you specific instructions on how to prepare for coronary bypass surgery.
He or she will tell you what to eat and drink, what medications to take, and what activities to stop (such as smoking).
You will likely be hospitalized on the same day of surgery.
If coronary artery disease tests show that you have severe blockages in your coronary (heart) arteries, your doctor may hospitalize you immediately.
You may have to undergo coronary bypass surgery on the same day or the next day.
What to expect during coronary bypass surgery
CABG requires a team of experts. A cardiac surgeon performs the surgery with the support of an anesthesiologist, a cardiologist, other surgeons, and nurses.
There are several types of CABG. They range from traditional surgery in which the chest is opened to access the heart, to unconventional surgery in which small incisions (cuts) are made to go around the blocked or narrowed artery.
Types of coronary bypass surgery
- Traditional coronary bypass surgery.
- Non-traditional coronary bypass surgery.
It involves non-traditional coronary bypass surgery:
- Off-pump coronary bypass
- Minimally invasive coronary bypass grafting
- Minimally invasive coronary bypass grafting
- Minimally invasive direct coronary bypass surgery
- Coronary bypass procedure
- Assistive robotics technology
Traditional coronary bypass surgery
This type of surgery usually lasts 3 to 5 hours, depending on the number of arteries being bypassed.
Several steps are performed during a traditional coronary bypass procedure.
You will be under general anesthesia for the coronary bypass surgery.
The term “anesthesia” refers to loss of sensation and consciousness.
General anesthesia puts you temporarily asleep.
During coronary bypass surgery, the anesthesiologist checks your heart rate, blood pressure, oxygen levels, and breathing.
A breathing tube is placed in your lungs through your throat.
The tube is connected to a ventilator (a machine that helps you breathe).
An incision is made down the center of your chest.
The breastbone is then cut and the rib cage is opened so the surgeon can access your heart.
Medications are used to stop your heart, allowing the surgeon to operate on it while it is not beating.
You are also given medications to protect the function of your heart during the time it’s not beating.
You can contact us to learn more about open-heart surgery without stopping the heart.
It has also become possible in Turkey to perform coronary bypass without the need for a large incision and opening of the ribs, but rather through a small incision of about 3 centimeters (called minimally invasive).
A heart-lung bypass machine keeps oxygen-rich blood moving throughout the body during coronary bypass surgery.
An artery or vein is taken from your body—for example, from your chest or leg—and prepared for use as a graft.
In coronary bypass surgery involving multiple pathways, both artery and vein grafts are commonly used.
Arterial grafts
These grafts are less likely to become blocked over time than vein grafts.
The left internal thoracic artery is often used for artery grafts.
Sometimes arteries from the arm or arteries from other places in the body are also used.
Vein grafting
Although veins are commonly used as grafts, they are more prone to plaque formation and clogging over time than arterial grafts.
The saphenous vein – a long vein that runs along the inner side of the leg – is usually used.
After the vaccination procedure, blood flow to your heart is restored.
Usually, the heart starts beating again on its own.
In some cases, mild electric shocks are used to restart the heart.
You are then disconnected from the heart-lung bypass machine.
Tubes are inserted into your chest to drain fluids.
The surgeon uses wires to close your breastbone (much like how broken bones are repaired). The wires stay in your body permanently.
After your chest bone heals, it will be as strong as it was before surgery.
Stitches or staples are used to close the skin incision.
The breathing tube is removed when you’re able to breathe without it.
Non-traditional coronary bypass surgery
Non-traditional coronary bypass surgery involves off-pump CABG and minimally invasive coronary artery bypass grafting.
Off-pump coronary artery bypass grafting
This type of surgery can be used to go around any of the coronary (heart) arteries.
Off-pump CABG is also called beating heart bypass because the heart does not stop beating, and a heart-lung bypass machine is not used.
Instead, the part of the heart where the graft is made is stabilized with a mechanical device.
Minimally invasive direct coronary artery bypass surgery
There are several types of minimally invasive direct CABG. These require only small incisions rather than opening the breastbone to access the heart.
These procedures sometimes use a cardiopulmonary bypass device.
Minimally invasive coronary artery bypass surgery
This procedure is used when only one or two coronary arteries need to be bypassed.
A series of small incisions are made between your ribs on the left side of your chest, just above the artery to be bypassed.
The incisions are typically about 3 inches long. (The incision made in a traditional CABG is at least 6 to 8 inches long.)
The left internal thoracic artery is often used for the graft.
A cardiopulmonary bypass device is not used during this procedure.
Coronary artery bypass surgery
This procedure is done through small incisions (ports) in your chest.
An artery or vein graft is used.
A cardiopulmonary bypass device is used during this procedure.
Assistive robotics technology
This type of procedure allows for smaller incisions the size of a keyhole.
A small video camera is inserted into one incision to show the heart, while the surgeon uses remote-controlled surgical instruments to perform the surgery.
A heart-lung bypass device is sometimes used during this procedure.
What to expect after coronary artery bypass grafting
Healing in the hospital
After surgery, you’ll usually spend a day or two in the intensive care unit (ICU).
Your heart rate, blood pressure, and oxygen levels will be checked regularly during this time.
An intravenous (IV) line will likely be inserted into a vein in your arm.
Through the IV line, you can receive medications to control your circulation and blood pressure.
You’re also likely to have a tube in your bladder to drain urine and a tube to drain fluid from your chest.
You may receive oxygen therapy (oxygen given through your nose or through a mask) and a temporary pacemaker while in the ICU.
A pacemaker is a small device placed in the chest or abdomen to help control abnormal heartbeats.
Your doctor may recommend wearing compression stockings on your legs as well.
These socks are tight at the ankle and become looser as they go up the leg.
This creates gentle pressure on the leg.
The compression prevents blood from pooling and clotting.
While in the ICU, you will also have bandages on your chest incision and on the areas where the artery or vein was removed for bypass.
After leaving the ICU, you will be moved to the ward for 3 to 5 days before going home.
Healing at home
Your doctor will give you specific instructions for recovering at home, especially regarding the following:
- How to care for your wound.
- How to recognize signs of infection or other complications.
- When to call a doctor immediately.
- When to make follow-up appointments.
You may also be given instructions on how to deal with common side effects from surgery. Side effects often go away within 4 to 6 weeks after surgery, but may include:
- Discomfort or itching from the healing incisions.
- Swelling in the area where the artery or vein was removed to divert it.
- Muscle pain or tightness in the shoulders and upper back.
- Fatigue, mood swings, or depression.
- Sleep issues or loss of appetite.
- Constipation.
- Chest pain around the site of the breastbone incision (more common with traditional CABG).
Full recovery from traditional CABG may take 6 to 12 weeks or longer.
Less recovery time is needed for unconventional CABG.
Your doctor will tell you when you can start physical activity again.
It varies from person to person, but there are some typical time periods.
Most people can resume sexual activity in about 4 weeks and driving after 3 to 8 weeks.
Returning to work after 6 weeks is common unless your job involves specific physical activity.
Some people may need to find less physically demanding types of work or work a reduced schedule at first.
Continuous care
Care after surgery may include regular checkups with doctors.
During these visits, tests may be done to see how your heart is working. Tests may include an electrocardiogram (EKG), stress test, echocardiogram, and computerized tomography of the heart.
CABG is not a cure for coronary heart disease (CHD).
You and your doctor may develop a treatment plan that includes lifestyle changes to help you stay healthy and reduce the chance of CHD worsening.
Lifestyle changes may include making changes to your diet, quitting smoking, getting regular physical activity, and reducing and managing stress.
Your doctor may also refer you to cardiac rehabilitation.
Cardiac rehabilitation is a medically supervised program that helps improve the health and well-being of people with heart conditions.
Rehabilitation programs include exercise training, education about heart-healthy living, and counseling to reduce stress and help you return to an active life.
Doctors oversee these programs, which may be offered in hospitals and other community facilities.
Talk to your doctor about whether cardiac rehabilitation may benefit you.
Taking medications as prescribed is also an important part of postoperative care.
Your doctor may prescribe medications to control pain during your recovery.
lower cholesterol and blood pressure, reduce the risk of blood clots forming, manage diabetes or treat depression.
What are the risks of coronary bypass?
Although complications from coronary bypass are uncommon, risks include:
- Wound infections and bleeding
- The effects of anesthesia on the body
- Fever
- Pain
- Stroke, heart attack, or even death
Some patients develop a fever with chest pain, irritability, and a lack of appetite.
This is due to inflammation of the lungs and heart after coronary bypass.
This complication sometimes appears one to six weeks after surgeries that involve cutting the pericardium (the outer shell of the heart).
This reaction is usually mild. However, some patients may develop fluid buildup around the heart that requires treatment after coronary bypass.
Memory loss and other changes, such as trouble concentrating or thinking clearly, may occur in some people after coronary bypass.
These changes are more likely to occur in people who are older, have high blood pressure or lung disease, or drink large amounts of alcohol.
These side effects often improve several months after surgery.
Using a cardiopulmonary bypass device during coronary bypass increases the risk of blood clots forming in your blood vessels.
Clots can travel to the brain or other parts of the body and block blood flow, which can cause a stroke or other issues.
Recent technical improvements in cardiopulmonary bypass devices help reduce the risk of blood clots forming.
Concerned about the risks of coronary bypass surgery?
At Bimaristan Medical Center in Turkey, we connect you with top surgeons and advanced hospitals to ensure safe, effective coronary bypass procedures with the highest care standards.
Contact us today and take the first step toward a healthier heart.
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