Coronary Artery Bypass Surgery

Bypass surgery is done to treat a heart attack and coronary artery disease. Surgery might be an option for many reasons. These reasons include the following:

• Your left main heart artery is very narrow.
• Multiple arteries of the heart are blocked or the amount of blood flowing through them is very low.
• You are going to have surgery to repair or replace a heart valve.
• You have diabetes and two or more narrowed or blocked arteries.
• Your heart is having trouble pumping. This is called a decreased ejection fraction.

Whether surgery is an option for you also depends on your age, your health, and how much your angina is affecting your quality of life. Your doctor is likely to recommend bypass surgery only if you will benefit from it and if those benefits are greater than the risks. You and your doctor can work together to decide if you want to have surgery.

The most common way to do bypass surgery is through a large cut, called an incision, in the chest. This is called open-chest surgery.

Your doctor will make the cut in the skin over your breastbone (sternum). Then the doctor will cut through your sternum to reach your heart and coronary arteries.

The doctor will likely connect you to a heart-lung bypass machine. This machine will let the doctor stop your heart during the surgery. The doctor will use a blood vessel from your chest, arm, or leg to bypass the narrowed or blocked arteries. When the blood vessels are in place, the doctor will restart your heart.

The doctor may use wire to put your sternum back together. The wire will stay in your chest. You will get stitches or staples to close the cuts in your skin. The cuts will leave scars that may fade in time.

Some hospitals offer less invasive bypass surgery. This includes surgery that is done without stopping the heart. The surgery also may be done through smaller cuts in the chest.

The risks during or soon after bypass surgery include:

• Infection.
• Kidney problems.
• Atrial fibrillation.
• Heart attack.
• Stroke.
• Short-term problems with thinking and memory. This is more common in older people. It tends to get better within several months of surgery.
• Death.

The chances of having a serious problem with bypass surgery increase with age. Your risk is also higher if you have other problems such as diabetes, kidney disease, lung disease, or peripheral arterial disease. Your doctor can help you understand what your risk for problems is. 

Bypass surgery:

• Can relieve stable angina symptoms and improve quality of life. You may be able to do more of your daily activities.
• May help certain people who have stable angina live longer. Whether it might help you live longer depends on several things. These include your overall health and which arteries need to be bypassed. For example, the surgery may raise your chances of living longer if you have diabetes and narrowing in your heart's larger arteries.
• Improves blood flow to the heart muscle after a heart attack.

Coronary artery bypass graft (CABG) is surgery to treat coronary artery disease. The surgery helps blood make a detour, or bypass, around one or more narrowed or blocked coronary arteries. Coronary arteries are the blood vessels that bring blood to the heart muscle. Your doctor did the surgery through a cut, called an incision, in your chest.

You will feel tired and sore for the first few weeks after surgery. You may have some brief, sharp pains on either side of your chest. Your chest, shoulders, and upper back may ache. These symptoms usually get better after 4 to 6 weeks. The incision in your chest and the area where the healthy blood vessel was taken may be sore or swollen.

You will probably be able to do many of your usual activities after 4 to 6 weeks. But for at least 6 weeks, you'll avoid lifting heavy objects and doing activities that strain your chest or upper arm muscles. At first you may notice that you get tired easily and need to rest often. It may take 1 to 2 months to get your energy back.

Some people find that they are more emotional after this surgery. You may cry easily or show emotion in ways that are unusual for you. This is common and may last for up to a year. Some people get depressed after the surgery. Talk with your doctor if you have sadness that continues or you are concerned about how you are feeling. Treatment and other support can help you feel better.

Even though the surgery may improve your symptoms, you will still follow a heart-healthy lifestyle to help lower your risk of a heart attack or stroke. It will be important to eat a heart-healthy diet, get regular exercise, stay at a healthy weight, manage other health problems, take your medicines, and not smoke.

You may start a cardiac rehabilitation (rehab) program in the hospital. You will continue with this rehab program after you go home to help you recover and prevent problems with your heart. Talk to your doctor about whether rehab is right for you.