What is a coronary artery bypass?

During coronary artery bypass surgery, the diseased sections of your coronary arteries are bypassed with healthy artery or vein grafts to increase blood flow to the heart muscle tissue. This procedure is also called coronary artery bypass grafting (CABG). Bypass typically requires open-chest surgery.

There are several newer, less invasive techniques for bypass surgery that can be used instead of open-chest surgery in some cases. In some procedures, the heart is slowed with medicine but is still beating during the procedure. For these types of surgery, a heart-lung bypass machine is not needed. (For open-chest surgery, a heart-lung machine is needed to circulate the blood and to add oxygen to it.) Other techniques use keyhole procedures or minimally invasive procedures instead of open-chest surgery. Keyhole procedures use several smaller openings in the chest and may or may not require a heart-lung machine. These techniques are still being studied and may not be available in all medical centers.

You'll receive anesthesia before the surgery that will make you sleep. In most cases, bypass surgery is open-chest surgery. During the surgery, your chest will be open and your heart exposed. The surgeon makes a large cut, or incision, in the middle or side of your chest. He or she may cut through your breastbone and spread apart your rib cage.

The surgeon removes a healthy blood vessel, often from the leg, and attaches (grafts) it to the blocked artery. The new blood vessel bypasses the blocked artery to increase blood flow to the heart. You may need just one bypass graft, or you may need more. Some people have as many as two, three or even four (double, triple or quadruple bypass surgery). How many grafts you need depends on how many arteries are blocked and where.

When the surgery is complete, the doctor may use wire to put your rib cage back together and stitches to close the incision. The surgery can take 3 to 6 hours. You will stay in the hospital at least 3 to 8 days after the surgery. It can take 4 to 6 weeks to recover at home. Most people are able to return to work within 1 to 2 months after surgery.

In some cases, a doctor will decide that coronary artery bypass is the treatment of choice for the patient's coronary heart disease (CHD). During this procedure, a blood vessel, usually taken from the leg, arm or chest, is grafted from the aorta onto the blocked artery, bypassing the blocked area. If more than one artery is blocked, several bypasses can be performed. This enables the blood to go around the obstruction and supply the heart with enough blood to relieve chest pain and prevent a heart attack.

Bypass surgery relieves symptoms of heart disease but does not cure it. You will typically need to take medications and make changes in your lifestyle after the operation.

The principle behind coronary artery bypass surgery is to construct a new channel that routes blood around a blockage in the coronary arteries. The cardiac surgeon takes a length of blood vessel from elsewhere in the body and places it so it can shunt blood around the narrowed or blocked coronary artery. This allows the heart muscle ordinarily supplied by that coronary artery to once more receive a full supply of oxygenated blood.

Coronary artery bypass surgery may be a better choice than angioplasty for people with blockages in multiple arteries. Clinical trials have shown that it also relieves the pain of angina more effectively on a long-term basis than angioplasty alone or angioplasty with stent insertion. And, in light of safety concerns about stents, doctors may be more likely to recommend bypass surgery for some people who might have otherwise undergone angioplasty with stent insertion.