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Bypass Surgery

What Is Coronary Artery Bypass Surgery?

Coronary artery bypass graft (CABG) surgery is one of the most common major operations. It’s used for people with narrow or blocked heart arteries (coronary artery disease, or CAD). CAD occurs when atherosclerotic plaque builds up in artery walls (hardening of the arteries). CABG surgery makes a new route, or bypass, around these arteries, so blood can get to the heart to deliver oxygen and nutrients. Three (triple), four (quadruple), or five (quintuple) bypasses are now routine.

Who Needs CABG Surgery?

People with angina who haven’t been helped by drugs or can’t have angioplasty may have CABG surgery. Other reasons for CABG surgery include angina after a heart attack (myocardial infarction, or MI), heart valve disorders, and other kinds of heart damage. CABG surgery is best for people with severe narrowing in many coronary artery branches, such as in diabetics.

How Is CABG Surgery Done?

Bypass grafting involves sewing the graft vessels to the coronary arteries to go around the narrowing or blockage. CABG surgery usually means using a heart-lung bypass machine. The heart is stopped while people are connected to this machine, which does the work of the heart. The machine adds oxygen to blood and circulates blood through the body. The heart is cooled with iced salt water, and a preservative solution is injected into the heart arteries to minimize damage. CABG surgery takes about 4 hours, and the bypass machine is used for about 90 minutes.

Several newer, less invasive methods may be used instead of open-chest surgery. They include off-pump coronary artery bypass, or OPCABG. It doesn’t use the bypass machine. The heart still beats during surgery. This method minimizes complications such as memory problems that may be seen after CABG. Other newer methods are minimally invasive surgery (uses a small incision) and robotic technology.

What Are the Risks of CABG Surgery?

Risks include needing another operation because blood clots cause grafts to be blocked. Grafts can get narrow after the first 5 years as scar tissue forms and atherosclerosis occurs. Internal mammary arteries remain open longer than do veins. Problems with anesthesia, heart attack, stroke, bleeding, infections, and abnormal heart rhythms also occur. Low-grade fever and chest pain could last up to 6 months. Some people have memory loss and problems thinking. During and shortly after CABG surgery, heart attacks occur in 5–10% of people and are the main cause of death.

DOs and DON’Ts in Managing CABG Surgery:
  • DO understand the risks of surgery. Talk to your health care provider about the operation and cardiovascular health.
  • DO make sure that your doctors have experience with CABG surgery.
  • DO use cholesterol-lowering medicines (such as statins) that your health care provider prescribes. LDL levels below 70 help long graft survival and reduce heart attack risk.
  • DO make lifestyle changes to be heart healthy: quit smoking, lower your cholesterol levels, keep to a healthy weight, control other conditions such as diabetes and high blood pressure, and exercise regularly.
  • DO call your health care provider after CABG if you develop shortness of breath, fever, unexplained bleeding or bruising, excessive weight gain or wound infection.
  • DON’T smoke or eat fatty foods.
  • DON’T forget: CABG surgery doesn’t cure CAD. Reducing risk factors and slowing atherosclerosis with lifestyle changes and medications are important.

Contact the following sources:

  • American Heart Association
    Tel: (800) 242-8721
  • American College of Cardiology
    Tel: (800) 253-4636

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

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