What Is Heart Bypass Surgery?

Heart bypass surgery is usually performed as an open-heart procedure, meaning the surgeon opens the chest in order to see the heart and perform surgery. It can be performed as a minimally invasive procedure, but that is less common as the technique is not appropriate for most patients.

The surgeon takes blood vessels from another part of the body, including the arm, chest, or legs, and connects them to blood vessels above and below the blocked artery/arteries. These grafts bypass the diseased artery and restore blood flow to the heart.

Heart bypass surgery is an inpatient procedure that requires a hospital stay. If you have had a heart attack or sudden cardiac arrest, it may be performed as emergency surgery. The surgery can also be scheduled in advance after evaluating your symptoms, test results, and medical history.

Contraindications

Outright contraindications include coronary arteries that aren’t compatible with grafting or heart muscle tissue that isn’t viable to graft. Even if these don't apply to you, bypass surgery will only be considered after weighing the risks and benefits in your case.

This is a major procedure. Your prognosis, age, and any comorbidities, among other things, will all factor into your healthcare provider's recommendation.

Potential Risks

The risks associated with an open-heart procedure increase with the number of bypasses required, as the surgery takes longer and the coronary artery disease being treated is more severe.

The risks of heart bypass surgery include:

• Heart rhythm problems
• Depression and mood swings
• Postpericardiotomy syndrome, which includes low fever, tiredness, and chest pain
• Infection
• Memory loss or loss of mental clarity
• Heart attack or stroke
• Kidney failure
• Lung failure

Purpose of Heart Bypass Surgery

Your healthcare provider may recommend bypass surgery if you have obstructive coronary artery disease (CAD), which means that plaque has built up in the arteries to the point that it is blocking the supply of blood to the heart.

Before surgery, your healthcare provider will likely order diagnostic tests to determine the extent of your coronary artery disease and the location(s) where arteries are narrowed.

These tests may include:

• Stress tests
• Echocardiogram
• Coronary angiography
• CT angiography
• Electrocardiogram (ECG or EKG)
• Coronary calcium scan

Depending on your overall health and results of your tests, your healthcare provider may suggest a coronary angioplasty instead of heart bypass surgery. This involves placing a stent to open blocked vessels. However, about a quarter of people who have an angioplasty must have it repeated, or have bypass surgery, within a few years.

If a heart bypass is planned, your healthcare provider will likely order additional tests to be done the day before your surgery. These include:

• Chest X-ray
• Urinalysis
• EKG of your heart
• Blood tests

How to Prepare

If you’re having a scheduled surgery, your surgeon will meet with you to discuss what to expect and how to prepare. Ask your surgeon about any questions you have, including when to bathe before surgery, when to arrive at the hospital, and what to expect the day of the surgery and during recovery.

Location

Heart bypass surgery occurs in a hospital setting in an operating room. Afterwards, the surgery team will take you to a room in the intensive care unit (ICU) to recover.

What to Wear

Wear loose comfortable clothes that you can change out of easily. Leave valuables, including jewelry, at home so you don’t have to worry about losing them. You’ll be given a hospital gown before the surgery and may be offered a blanket to help you stay warm.

Food and Drink

You should stop eating and drinking by midnight the day before the surgery. Check with your healthcare provider or surgeon to make sure there are no other restrictions.

Medications

Ask your healthcare provider whether you should continue to take your medications before the surgery. About a week before the surgery, they may want you to stop taking medications that would increase the risk of bleeding, including aspirin, ibuprofen, and naproxen.

If you take Plavix (clopidogrel), ask your healthcare provider when you should stop taking it.

To avoid complications, make sure your healthcare provider knows about all medications, vitamins, and supplements you’re taking before the surgery.

What to Bring

Remember to bring any paperwork from your healthcare provider as well as insurance cards. Pack a small bag with a change of clothes for when you leave the hospital.

Make arrangements for someone to bring you home from the hospital and for someone to stay with you at home for at least one or two weeks while you recover, if possible.

Pre-Op Lifestyle Changes

You should stop smoking before the surgery. It may make you more likely to have mucus in your lungs, which is hard to remove after surgery. Ask your healthcare provider about suggestions for how to quit.

Day of Surgery : What to Expect

The day of your surgery, you may meet with members of your heart care team, including your surgeon and anesthesiologist, to go over the details of your bypass surgery.

Before the Surgery

You’ll be asked to remove any jewelry, dentures, hair clips, and nail polish. Your chest, groin and legs will be shaved. Your nurse will start an IV to give you fluids.

You might also receive medications to help you relax and a facemask to help you breathe oxygen. You’ll be given general anesthesia so you won’t feel any pain and will be asleep for the surgery.

During the Surgery

• The procedure starts with dividing the breastbone to spread the ribs. A heart-lung machine will do the work of the heart and lungs before the surgery. A cardiac perfusionist monitors the heart-lung machine during your procedure. In some cases, heart bypass surgery is performed without a heart-lung machine while the heart is still pumping. This may be safer for those who have a higher risk of complications from using a heart-lung machine, including patients who are elderly and those with ventricular dysfunction, diabetes, chronic lung disease, and kidney disease.

• The surgeon will remove blood vessels from another area of the body, typically the leg and the left side of the chest. These vessels are then sewn onto the existing heart vessel before and after the blockage so that blood flows around, not through, the problematic artery. This is similar to a detour when there's a road closure.
• Once the surgeon has finished the procedure, they’ll restart your heart and sew your breastbone back together. Chest tubes are placed to drain fluid that might otherwise build up around your heart and prevent it from functioning well. These tubes are typically removed within a few days of surgery.
• The anesthesiologist will monitor your vital signs throughout the surgery. The surgery can take four to six hours, depending on the technique being used and whether you are having a single, double, triple, or quadruple bypass.

After the Surgery

You’ll be taken to the ICU to recover, where you will likely remain for the first couple of days. You will come out of surgery with a breathing tube in place. As you wake up and start breathing on your own, the tube will be removed. 

For most patients, the goal for the first 12 hours after surgery is not only to wake up and have the breathing tube removed, but to take a few steps and sit up in a chair at least once (preferably twice). This is aimed at not only starting the recovery process but preventing serious complications like blood clots and pneumonia.

While you’re in the ICU, your care team will likely do the following:

• Apply bandages on your chest and areas where the vessels were removed
• Attach a catheter to your bladder to drain urine
• Connect an ECG to monitor your heart’s rhythm
• Implant a temporary pacemaker, which will be removed prior to discharge
• Monitor your vital signs, including blood pressure and oxygen
• Provide oxygen therapy through a mask or nasal prongs

When your time in the ICU is done, you will move to a regular or transitional care room to finish out your hospital stay, which may be about a week total.

Recovery

Recovery from this procedure begins in the hospital and continues at home. You will likely feel better around four to six weeks post-surgery, but full recovery can take several months. Your surgeon will want to see you for a follow-up about four weeks after you're discharged, so make sure you set up the appointment.

Activity

Your healthcare provider will probably encourage you to begin cardiac rehabilitation -physical exercise performed under the watchful eye of a therapist- within a few days to help strengthen the heart.

As your recovery progresses, you’ll gradually be able to resume other activities. Walking is good exercise - just remember to keep a slow pace. Stop if you feel dizzy, out of breath, or have any pain in your chest.

You may be able to return to work about six to eight weeks after surgery. Do not drive for at least four to six weeks afterwards.

Check with your surgeon and cardiac rehab therapist about any other restrictions you should follow.

Healing

At home, you should shower every day and wash the incision gently. Do not take a bath, swim, or soak in a hot tub until your wound is completely healed.

In the first weeks after the surgery, you may experience symptoms including:

• Pain around your incision
• Shortness of breath
• Itchy, numb, or tingly skin around the incisions (may last for months)
• Poor appetite
• Difficulty sleeping
• Constipation
• Feeling tired

When to Call Your Healthcare Provider

Talk to your healthcare provider or surgeon immediately if you have:

• Pain, redness, heat, or drainage from your incision
• Temperature of 101 degrees F or higher
• Weight gain of more than 2 pounds a day for two days in a row
• Irregular pulse (either very fast or very slow)
• Shortness of breath
• Dizziness or fainting
• Severe headache
• Cough that doesn’t go away
• Coughing up blood or yellow or green mucus

Coping with Recovery

Recovery from heart bypass surgery takes time. The full benefits of the surgery may not be realized until up to six months after it is performed.

While it’s good to stay active, and you may want to jump back into your regular life, remember to take things slow. To avoid complications and setbacks, talk to your healthcare provider about your path to recovery and what you can safely handle.

If you’re feeling depressed or experiencing mood swings, let your healthcare provider know. They can suggest a counselor who can help you. Also, reach out to family and friends. Let them know specific ways they can help, whether that’s pitching in with chores or finding activities you can enjoy together.

Lifestyle Adjustments

Part of both your recovery and care long after your surgery is performed is implementing healthier lifestyle changes. Without this, the chances that you will need a second surgery will increase.

Follow your healthcare provider’s instructions for how to prevent any future coronary artery blockages. This should include:

• Eating a heart-healthy diet
• Exercising regularly
• Treating high blood pressure, high blood sugar, or high cholesterol
• Not smoking

Continue to take any medications that your healthcare provider prescribes, whether it’s for your heart or another condition.