Heart bypass surgery

Answer 1

Definition

Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to reach your heart. It is done to fix problems caused by coronary artery disease (CAD), in which the arteries that lead to your heart are partly or totally blocked.

See also:

• Heart bypass surgery - minimally invasive
• Angioplasty and stent placement

Alternative Names

Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery

Description

Before your surgery you will receive anesthesia. This will make you unconscious and unable to feel pain. The effects of the anesthesia will last the entire procedure.

Once you are unconscious, the heart surgeon will make a 10-inch-long incision (cut) in the middle of your chest. Then your breastbone will be separated to create an opening that allows the surgeon to see your heart and aorta (the main blood vessel leading from the heart to the rest of your body).

Most people who have coronary bypass surgery are connected to a heart-lung bypass machine, or bypass pump.

• This machine does the work of your heart while your heart is stopped for the surgery. The machine adds oxygen to your blood, and circulates your blood through your body.
• Your heart is stopped while you are connected to this machine.

A newer method does not use the heart-lung bypass machine. The bypass is created while your heart is still beating. This is called off-pump coronary artery bypass, or OPCAB. This method may be used for patients who could have problems from being on the heart-lung machine.

During this surgery, the doctor takes a vein or artery from another part of your body and uses it to create a detour (or graft) around the blocked area in your artery.

• Your doctor may use a vein, called the saphenous vein, in your leg. To reach this vein, an incision will be made along the inside of your leg, between your ankle and the groin. One end of the graft will be sewn to your coronary artery. The other end will be sewn to an opening that will be made in your aorta.
• The internal mammary artery (IMA), in your chest, can also be used as the graft. One end of the IMA is already connected to your aorta, so just one end will need to be attached. It will be sewn to your coronary artery.
• Other arteries are also now being used for grafts in bypass surgery. The most common one is the radial artery, in your wrist.

After the graft has been created, your breastbone will be reconnected with wire, and your incision will be sewn closed. The wire will remain inside you.

This surgery can take 4 to 6 hours. After the surgery, you will be taken to the Intensive Care Unit.

Why the Procedure Is Performed

Coronary arteries are the small blood vessels that supply your heart with oxygen and nutrients that are carried in your blood.

When one or more of the coronary arteries becomes partly or totally blocked, your heart does not get enough blood. This is called ischemic Heart disease, or coronary artery disease (CAD). It can cause chest pain (angina).

Coronary artery bypass surgery can be used to treat coronary artery disease. Your doctor may have tried to treat you with medicines only. You may have also tried cardiac rehabilitation.

CAD varies a lot from person to person, so the way it is diagnosed and treated will also vary. Heart bypass surgery is just one treatment. It will be right for some people, but others may have other kinds of treatment.

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the lungs, urinary tract, and chest
• Blood loss

Possible risks from having coronary bypass surgery are:

• Heart attack or stroke
• Sternal (chest) wound infection, which is more likely to happen in people who are obese, have diabetes, or have already had this surgery
• Post-pericardiotomy syndrome, which is a low-grade fever and chest pain. It could last up to 6 months.
• Some people report memory loss and loss of mental clarity, or "fuzzy thinking."
• Heart rhythm problems

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

During the days before your surgery:

• For the 2-week period before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery. They include aspirin, ibuprofen (such as Advil and Motrin), naproxen (such as Aleve and Naprosyn), and other similar drugs. If you are taking clopidogrel (Plavix), talk with your surgeon about when to stop taking it.
• Ask your doctor which drugs you should still take on the day of the surgery.
• If you smoke, try to stop. Ask your doctor for help.
• Always let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness.
• Prepare your home for when you are discharged from the hospital.

The day before your surgery:

• Shower and shampoo well.
• You may be asked to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap.
• You also may be asked to take an antibiotic, to guard against infection.

On the day of the surgery:

• You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes Chewing Gum and breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
• Take the drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

After the operation, you will spend 5 to 7 days in the hospital. You will spend the first few hours in an intensive care unit (ICU).

Two to 3 tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 to 3 days after surgery.

You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV) lines for fluids. There will be monitors that give information about your vital signs (pulse, temperature, and breathing). Nurses will watch your monitors constantly.

Usually within 24 hours, you will be moved to a regular or a transitional care unit in the hospital, and you will slowly resume some activity. You may begin a cardiac rehabilitation program within a few days.

It takes 4 to 6 weeks to start feeling better after surgery.

Outlook (Prognosis)

Recovery from surgery takes time, and you may not see the full benefits of your surgery for 3 to 6 months. In most people who have heart bypass surgery, the grafts remain open and working well for many years.

But, this surgery does NOT prevent the coronary artery blockage from coming back. You can do many things to slow it down. Not smoking, eating a heart-healthy diet, getting regular exercise, and treating high blood pressure, high blood sugar (if you have diabetes), and high cholesterol will all help and are very important.

You may be more likely to have problems with your blood vessels if you have kidney disease or some other medical problems.

References

Ferraris VA, Mentzer RM Jr. Acquired heart disease: coronary insufficiency. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 61.

Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. Circulation. 2007;116(23):2762-2772.

Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, et al. Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl J Med. 2008;358:331-341.

Answer 2

Heart bypass surgery begins with an incision made in the chest, with the breastbone cut exposing the heart. Next, a portion of the saphenous vein is harvested from the inside of the leg. Pieces of this great vein will be used to bypass the blocked arteries in the heart. The venous graft is sewn to the aorta and to the affected coronary artery past the blocked site. The internal mammary artery from the chest may also be used to bypass a clogged artery. Several arteries may be bypassed depending on the condition of the heart.

Reviewed By

Review Date: 05/06/2011

Shabir Bhimji MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

Definition

Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to reach your heart.

See also:

• Angioplasty and stent placement
• Heart bypass surgery - minimally invasive

Alternative Names

Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery

Description

Before your surgery you will get general anesthesia. You will be asleep (unconscious) and pain-free during surgery.

Once you are unconscious, the heart surgeon will make a 8-10-inch surgical cut (incision) in the middle of your chest. Your breastbone will be separated to create an opening. This allows your surgeon to see your heart and aorta, the main blood vessel leading from the heart to the rest of your body.

Most people who have coronary bypass surgery are connected to a heart-lung bypass machine, or bypass pump.

• Your heart is stopped while you are connected to this machine.
• This machine does the work of your heart while your heart is stopped for the surgery. The machine adds oxygen to your blood, and moves your blood through your body.

A newer type of bypass surgery does not use the heart-lung bypass machine. The bypass is made while your heart is still beating. This is called off-pump coronary artery bypass, or OPCAB. This procedure may be used if you could have problems while on the heart-lung machine.

During bypass surgery, the doctor takes a vein or artery from another part of your body and uses it to make a detour (or graft) around the blocked area in your artery.

• Your doctor may use a vein, called the saphenous vein, from your leg. To reach this vein, a surgical cut will be made along the inside of your leg, between your ankle and groin. One end of the graft will be sewn to your coronary artery. The other end will be sewn to an opening made in your aorta.
• A blood vessel in your chest, called the internal mammary artery (IMA), can also be used as the graft. One end of this artery is already connected to your aorta. The other end is attached to your coronary artery.
• Other arteries can also be used for grafts in bypass surgery. The most common one is the radial artery in your wrist.

After the graft has been created, your breastbone will be closed with wire. This wire stays inside you. The surgical cut will be closed with stitches.

This surgery can take 4 to 6 hours. After the surgery, you will be taken to the intensive care unit.

Why the Procedure Is Performed

Your doctor may recommend this procedure if you have a blockage in one or more of your coronary arteries. Coronary arteries are the small blood vessels that supply your heart with oxygen and nutrients that are carried in your blood.

When one or more of the coronary arteries becomes partly or totally blocked, your heart does not get enough blood. This is called ischemic heart disease, or coronary artery disease (CAD). It can cause chest pain (angina).

Coronary artery bypass surgery can be used to treat coronary artery disease. Your doctor may have first tried to treat you with medicines. You may have also tried cardiac rehabilitation or angioplasty with stenting.

Coronary artery disease is different from person to person. The way it is diagnosed and treated will also vary. Heart bypass surgery is just one treatment. It is not right for everyone.

Risks

Risks for any surgery include:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the lungs, urinary tract, and chest
• Blood loss

Possible risks from having coronary bypass surgery include:

• Chest wound infection, which is more likely to happen if you are obese, have Diabetes, or have already had this surgery
• Heart attack or stroke
• Heart rhythm problems
• Kidney or lung failure
• Low fever and chest pain, together called post-pericardiotomy syndrome, which can last up to 6 months
• Memory loss, loss of mental clarity, or "fuzzy thinking"

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

During the days before your surgery:

• For the 2-week period before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery. They include aspirin, ibuprofen (such as Advil and Motrin), naproxen (such as Aleve and Naprosyn), and other similar drugs. If you are taking clopidogrel (Plavix), talk with your surgeon about when to stop taking it.
• Ask your doctor which drugs you should still take on the day of the surgery.
• If you smoke, try to stop. Ask your doctor for help.
• Contact your doctor if you have a cold, flu, fever, herpes breakout, or any other illness.
• Prepare your home so you can move around easily when you return from the hospital.

The day before your surgery:

• Shower and shampoo well.
• You may be asked to wash your whole body below your neck with a special soap. Scrub your chest two or three times with this soap.

On the day of the surgery:

• You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
• Take any medications that your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

After the operation, you will spend 3 to 7 days in the hospital. You will spend the first night in an intensive care unit (ICU). You will probably be moved to a regular or transitional care room within 24 hours.

Two to three tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 to 3 days after surgery.

You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV) lines for fluids. You will be attached to machines that monitor your pulse, temperature, and breathing. Nurses will watch your monitors constantly.

You will be encouraged to restart some activities and may begin a cardiac rehabilitation program within a few days.

It takes 4 to 6 weeks to start feeling better after surgery.

Outlook (Prognosis)

Recovery from surgery takes time. You may not see the full benefits of your surgery for 3 to 6 months. In most people who have heart bypass surgery, the grafts stay open and work well for many years.

This surgery does not prevent the coronary artery blockage from coming back. You can do many things to slow this process down, including:

• Not smoking
• Eating a heart-healthy diet
• Getting regular exercise
• Treating high blood pressure
• Controlling high blood sugar (if you have diabetes) and high cholesterol

You may be more likely to have problems with your blood vessels if you have kidney disease or continue to smoke.

References

Ferraris VA, Mentzer RM Jr. Acquired heart disease: coronary insufficiency. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 61.

Morrow DA, Boden WE. Stable ischemic heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 57.

Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, et al. Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl J Med. 2008;358:331-341.

MA¸ller CH, Perko MJ, Lund JT, Andersen LW, Kelbaek H, Madsen JK, Winkel P, Gluud C, SteinbrA1/4chel DA. No major differences in 30-day outcomes in high-risk patients randomized to off-pump versus on-pump coronary bypass surgery: the best bypass surgery trial. Circulation. 2010 Feb 2;121(4):498-504.

Reviewed By

Review Date: 05/06/2011

Shabir Bhimji MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.