What happens during the procedure?
Coronary artery bypass graft surgery is performed on an inpatient basis in the hospital while you are under general anesthetic, so you won't be awake during the procedure. The procedure takes from three to six hours depending on how many arteries need to be bypassed.
There are several steps to this procedure.
- Your surgeon will cut through your chest bone in order to have access to the heart and arteries.
- Next, the surgeon will remove a healthy piece of blood vessel from the leg, arm, or chest, which will be used to reroute blood flow to the heart.
- Your surgeon needs to stop your heart to perform the bypass, so you will be connected to a heart-lung bypass machine. During the grafting procedure, the heart-lung bypass machine will act in place of your heart, adding oxygen to the blood and pumping it through your body.
- Your surgeon will attach the healthy blood vessels around the damaged arteries, creating a route for your blood to bypass the narrowed and damaged arteries.
- Once the bypasses have been created, your surgeon will restart your heart,
ensure the bypass is functioning properly, put the chest bone back together, and sew up your chest.
There are newer, less invasive, techniques for performing coronary artery bypass graft surgery. These include "beating heart surgery", which means the heart does not have to be stopped and there is no need for the heart-lung bypass machine. As well, there are minimally invasive techniques which require smaller incisions rather than opening the whole chest.
How should I prepare for this procedure?
Your doctor or surgeon will provide you with a complete list of instructions before your surgery. In the weeks before the surgery, your doctor will likely order a number of blood tests as well as an X-ray and other tests to determine the size and shape of your heart.
You will require a coronary angiogram to confirm that bypass surgery is needed and possible and to locate the blockages in the arteries.
If you are on medication that affects your blood's clotting ability, your doctor may tell you to stop taking it before the surgery to decrease the risk of bleeding or blood clots. You may be given an anticoagulant before surgery that is different than the one you usually use.
Patients are usually admitted to the hospital the day before the surgery; you will be told by the nurse what needs to be done to prepare you for the surgery.
Do not eat for 8 hours before the procedure. You may continue to drink clear liquids until 2 hours before the procedure. If your doctor has recommended different times, follow the timing recommended by your doctor.
Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any medication allergies and medical conditions that you may have. Ask your doctor or pharmacist whether you need to stop taking any of your medications before the procedure.
Ask your doctor or pharmacist whether you need to stop taking any of your medications before the procedure.
What can I expect after the procedure?
Following surgery, you will likely spend one to two days in the hospital's intensive care unit, followed by several more days in the hospital. In the first few days after surgery, you will likely be connected to equipment to monitor your heart, blood pressure, and other functions, as well as to tubes to supply you with food and medication, and to other tubes to remove waste.
To reduce the risk of complications, your doctor may prescribe medications for pain and to prevent harmful blood clotting.
The incision may be sore and usually takes a few months to heal. During this time you should avoid disturbing the area by scratching it or unnecessarily touching it. After the surgery, you will need to support your chest bone by putting pressure on it with a pillow whenever you get up or cough.
Usually three or four months is needed for full recovery, but within a few weeks most people can return to most of the activities they did before the surgery. Driving is not recommended for at least one month after the surgery.
Recovery from coronary artery bypass graft surgery requires an intensive rehabilitation program, including physical, respiratory, and occupational therapy as well as possible changes to your diet. It is important to adopt the recommended lifestyle changes following the procedure as blockages in the coronary arteries can reoccur.
Results
Coronary artery bypass graft surgery does not cure coronary artery disease nor stop it from progressing. As a result, blockages may develop in other arteries or in the blood vessel that was used as a bypass. How long the grafts stay open depends on the type of grafts used and the individual characteristics of each patient (e.g., lifestyle habits, genetic make-up). Arterial grafts tend to last longer than vein grafts. Risk factors such as smoking or having abnormal cholesterol levels may cause either type of graft to narrow more quickly.
An estimated 2% to 3% of patients require a second surgery within five years. For patients with vein grafts, about half of them develop chest pain caused by severe or complete blockages of the grafts after 10 years.