If your arteries are narrowed or blocked in several areas, or if you have a blockage in one of the larger main arteries, coronary bypass surgery may be necessary. During bypass surgery, a section of healthy blood vessel — often taken from inside the chest wall or the lower leg — is attached above and below the blocked artery. This lets blood flow around the blocked area to the heart muscle.
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Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. One major factor is that LAD bypass uses another artery—the mammary artery, located in the chest near the heart—for the graft. Complications are rare, and CABG using the mammary artery lasts for decades. Moreover, for reasons still unknown, the mammary artery is nearly immune to blockage.
Medical therapy here means medication and follow-up visits with your cardiologist, but no invasive interventions such as bypass or angioplasty. These procedures typically use veins rather than arteries, and in half of people, these repurposed veins start to fail after eight to 10 years.
For people with diabetes, there are fewer questions regarding the choice between bypass surgery and stents. Bypass surgery is generally superior to angioplasty. When more than one heart artery is blocked, CABG may also offer better survival rates for people with heart failure. As a service to our readers, Harvard Health Publishing provides access to our library of archived content.
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Get helpful tips and guidance for everything from fighting inflammation to finding the best diets for weight loss Once the bypass grafts have been checked, the doctor will let the blood circulating through the bypass machine back into your heart and he or she will remove the tubes to the machine.
Your heart may restart on its own, or a mild electric shock may be used to restart it. Your doctor may put temporary wires for pacing into your heart. These wires can be attached to a pacemaker and your heart can be paced, if needed, during the initial recovery period. Once your doctor has opened the chest, he or she will stabilize the area around the artery to be bypassed with a special instrument. The heart-lung bypass machine and the person who runs it may be kept on stand-by just in case the procedure need to be completed on bypass.
The doctor will do the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage. You may have more than one bypass graft done, depending on how many blockages you have and where they are located. Before the chest is closed, the doctor will closely examine the grafts to make sure they are working.
Your doctor will sew the sternum together with small wires like those sometimes used to repair a broken bone. He or she will insert tubes into your chest to drain blood and other fluids from around the heart. Your doctor will put a tube through your mouth or nose into your stomach to drain stomach fluids. After the surgery, you will be taken to the intensive care unit ICU to be closely monitored.
Machines will constantly display your electrocardiogram ECG tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. Coronary artery bypass surgery CABG requires an in-hospital stay of at least several days. You will most likely have a tube in your throat to help with breathing through a ventilator breathing machine until you are stable enough to breathe on your own.
As you continue to wake up from the anesthesia and start to breathe on your own, your doctor can adjust the breathing machine to allow you to take over more of the breathing. When you are awake enough to breathe completely on your own and you are able to cough, your doctor will remove the breathing tube.
After the breathing tube is out, a nurse will help you cough and take deep breaths every couple of hours. This will be uncomfortable due to soreness, but it is very important that you do this to keep mucus from collecting in your lungs and possibly causing pneumonia.
Your nurse will show you how to hug a pillow tightly against your chest while coughing to help ease the discomfort. The surgical incision may be tender or sore for several days after a CABG procedure. Take a pain reliever for soreness as recommended by your doctor.
Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines. Your doctor may delivery medicines through the IV to help your blood pressure and your heart, and to control any problems with bleeding. As your condition stabilizes, he or she will gradually decrease and then stop these medicines. Once your doctor removes the breathing and stomach tubes and you are stable, you may start to drink liquids.
You can gradually include more solid foods as you can handle them. When your doctor determines that you are ready, you will be moved from the ICU to a post-surgical nursing unit. Your recovery will continue there. This allows blood to reach the heart again. Surgeons can address more than one artery in a single operation. A double bypass involves two repairs, a triple bypass involves three, and a quadruple bypass involves four.
The quintuple bypass is the most intricate heart bypass surgery and includes all five of the major arteries feeding the heart. Removing a blood vessel from another part of the body will not substantially affect blood flow in the area the vessel came from.
Heart bypass surgery is typically an open-heart surgery , which means that the surgeon cuts the chest open to reach the heart. On-pump surgery involves using a heart-lung machine that circulates blood and breathes for the body. The machine allows doctors to stop the heart, which makes the operation easier. Risks and potential complications vary for each person.
A doctor can help decide which treatment is the best option for each person. Before heart bypass surgery, people should:. A person undergoing a planned heart bypass operation will have an opportunity to discuss the procedure with their doctor before the operation.
The care team will explain the surgery, set up arrival times, and help complete paperwork. Many people may undergo tests before the surgery including an electrocardiogram EKG , chest X-ray, and blood tests.
The IV will allow fluids and medicines to enter the body as needed. A member of the healthcare team might also shave the areas where a surgeon will make their incisions. Immediately before the surgery, the doctors provide medicine that causes a deep sleep until after the operation. Surgeons perform hundreds of thousands of heart bypass operations each year and many of those who have the surgery get relief from their symptoms without needing long-term medication.
The more severe the heart disease , the higher the risk of complications. However, the mortality rate is low, and according to one report, only 2—3 percent of people who undergo heart bypass surgery die as a result of the operation.
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