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Bypass Surgery

Understanding Bypass Surgery

It is important for you to know as much as possible about how your heart functions in order to have complete understanding of bypass surgery.

Your heart is a muscle that pumps blood throughout your body. To do its work, your heart needs a constant supply of oxygen-rich blood that it gets from the lungs.

Coronary arteries are the blood vessels that wrap around the heart muscle and keep it supplied with oxygen-rich blood. When blood is pumped by the left ventricle, it is forced into the body's largest artery, the aorta, located at the top of the heart. Two coronary arteries, the left main artery and the right coronary artery, branch off the aorta.

The left main artery is about as wide as a drinking straw and less than an inch long. It branches into two narrower arteries: the left anterior descending, which travels down the front side of the heart, and the left circumflex, which circles around the left side and then to the back of the heart. The right coronary artery branches from the aorta, circles around the right side and then to the back of the heart. They divide into smaller branches, similar to a tree, and go deep into the heart muscle carrying oxygen-rich blood to the cells.

Diagnosing your problem

If you have a blockage in one or more of your arteries, the blood supply to your heart is severely compromised. The chest pain, chest discomfort, arm pain, or other symptoms you may have experienced are the warning signs that your heart muscle is not getting enough blood. If this persists, you could suffer a heart attack and the muscle will be damaged.


What causes a blocked artery?

Atherosclerosis is the buildup of fatty deposits on the inside of the arteries. They become narrow and reduce the blood flow to the heart (like a clogged drain).


Where does atherosclerosis come from?

Cholesterol is a necessary component of the human cell; but, over time, cholesterol in the blood can become deposited on the inside walls of the arteries. This seems to happen faster in people who:

  • smoke
  • have high blood pressure
  • eat high fat, high cholesterol foods, or, for other reasons, have high cholesterol
  • are overweight
  • have a lot of tension and stress
  • do not exercise regularly
  • have diabetes and/or family members with a history of atherosclerosis.

How do we determine if you need bypass surgery?

A cardiac catheterization may be done. Pictures, called angiograms, are taken to show the blockages.


What is bypass surgery?

Sometimes referred to as CABG (sounded out as "cabbage"), coronary bypass surgery is an operation in which other blood vessels are used to go around, or bypass, clogged coronary arteries. Blood can then flow freely to the heart through the new "arteries".


How do I prepare for bypass surgery?

Rest, eat well, quit smoking, and walk or do the exercise allowed by your doctor. Several routine tests are done before surgery: EKG, echocardiogram, chest x-ray, blood tests, medical history and exam. Make a list of any questions you have and ask the doctor before surgery. You will receive specific instructions before surgery to completely prepare you for the procedure.


What happens before surgery?

The morning of surgery you will be given medication to make you feel relaxed and drowsy. You will be taken to surgery and will be in the operating area for several hours. The waiting time will seem long to your family, but the heart surgery will not take that long.


Tell me about bypass surgery.

The operation will take 2-1/2 to 5 hours. The surgeon will connect you to a coronary bypass machine (heart/lung machine) which assumes the function of your heart and lungs until the surgery is completed. The surgeon takes a blood vessel from your leg and attaches one end to the aorta (the large artery that comes out of the heart) and the other end to the coronary artery below the point where it is blocked-this is the bypass. A blood vessel from within the chest may also be used. Blood now flows freely through the new bypass graft to the heart.


What happens to the blockage?

The blockage remains as is. The blood supply has been rerouted around it to the heart muscle.


What are the risks?

Almost half a million bypass surgeries are performed each year. As in all major surgery, there are risks. Coronary bypass surgery has an excellent success rate. There is a small risk of stroke, bleeding, infection, heart attack or death. After careful review of your medical history and a physical exam, your surgeon will identify your risks.


How will I feel after my bypass?

You will wake up in the ICU (Intensive Care Unit), and you may feel confused at first. Your family will be able to visit briefly. Be assured you are in capable, caring hands. You may be uncomfortable and unable to talk, but the nurses will help you communicate. The equipment surrounding you helps you to breathe, measures heart function, checks your blood pressure and heart rate, and kidney function. After all your vital signs are stable and you are doing well, you'll be sitting up in a chair.

Most of the tubes and catheters will be removed within a day or two, and you'll be moved to a regular room. You will be asked to breathe deeply and cough hard to clear any fluids from your lungs. You will feel sore, and you may experience night sweats, moodiness, or even feel down. This is all quite normal. The surgeon may prescribe medication to keep you comfortable. If you are in pain, don't hesitate to tell your nurse or doctor so that pain medication can be prescribed for you.
The nurses will have you moving and walking around right away. Within a few days you will eat a normal meal and begin to feel better each day.


What can I do when I return home?

Your surgeon and the hospital staff will discuss any restrictions you may have.

Your doctor will see you a few weeks after surgery. After six to eight weeks, you should be 80% recovered and completely recovered from the operation within three months. Most people with sedentary office jobs can return to work in four to six weeks; those with physically demanding jobs will have to wait longer.

You may be instructed to make some changes in your life style such as reducing your consumption of fat and cholesterol, and exercising daily.