What is coronary artery bypass surgery?

Coronary artery bypass is surgery to treat coronary artery disease. It helps blood make a detour, or bypass, around one or more narrowed or blocked coronary arteries. These arteries are the blood vessels that bring blood to the heart muscle. This is also called coronary artery bypass graft (CABG) or bypass surgery.

Your doctor will make the bypass with a healthy piece of blood vessel from another part of your body. Then the doctor will attach, or graft, the healthy blood vessel to the narrowed or blocked artery. The new blood vessel bypasses the diseased artery to increase blood flow to the heart muscle.

The doctor typically makes a cut in the skin over your breastbone (sternum). This cut is called an incision. Then the doctor will cut through your sternum to reach your heart and coronary arteries. The doctor may connect you to a heart-lung bypass machine. It adds oxygen to the blood and moves the blood through the body. The machine will allow the doctor to stop your heartbeat while working on your arteries. The doctor will use blood vessels from your chest, arm, or leg to bypass the narrowed or blocked parts of your arteries. When the blood vessels are in place, the doctor will restart your heart. In some cases, the doctor may be able to do the surgery without using a heart-lung machine. This is called "off-pump" surgery.

The doctor may use wire to put your sternum back together. Stitches or staples will be used to close the incisions in the skin over your sternum and where your healthy blood vessel was taken. The wire will stay in your chest. The incisions will leave scars. They may fade with time.

You will stay in the hospital for a few days after surgery. You will probably be able to do many of your usual activities after 4 to 6 weeks. But for at least 6 weeks you will avoid lifting heavy objects and doing things that strain your chest or upper arm muscles. At first you may notice that you get tired quickly. You may need to rest often. It may take 1 to 2 months before your energy is back to normal.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. Try to sleep on your back while you heal. If your breastbone (sternum) was cut, healing usually takes about 4 to 6 weeks.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or heavy aerobic exercise, until your doctor says it is okay.
• For 3 months, avoid activities that strain your chest or upper arm muscles. This includes pushing a lawn mower or vacuum, mopping floors, or swinging a golf club or tennis racquet.
• For at least 6 weeks, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, or cat litter or dog food bags.
• For at least 6 weeks, avoid pushing yourself up out of a bed or chair using your arms. Do not use your arms to pull yourself into or out of a vehicle.
• Hold a pillow firmly over your chest incision when you cough or take deep breaths. This will support your chest and reduce your pain.
• Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.
• Ask your doctor when you can drive again.
• You may need to take 4 to 12 weeks off from work. It depends on the type of work you do and how you feel.
• Ask your doctor when it is okay for you to have sex.

Diet

• Eat a heart-healthy diet. If you have not been eating this way, talk to your doctor. You also may want to talk to a dietitian. A dietitian can help you learn about healthy foods.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Do not take aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), or other nonsteroidal anti-inflammatory drugs (NSAIDs) unless your doctor says it is okay.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• Your doctor may give you a blood thinner to prevent blood clots. If you take a blood thinner, be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.

Incision care

• If you have strips of tape on the incisions the doctor made, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• You can take showers with your back to the showerhead. Allow the warm and soapy water to run across your shoulders and down over the incision. Pat the incision dry with a clean towel.
• Do not take a bath for the first 3 weeks, or until your doctor tells you it is okay.
• Do not swim or use a hot tub for at least 1 month, or until your doctor says it is okay.
• Do not use any creams, lotions, powders, ointments, or oils unless your doctor tells you it is okay.
• If a vein was removed from your leg, you can help prevent swelling by:
  • Wearing compression stockings if your doctor recommends them.
  • Elevating your legs above the level of your heart whenever you lie down.

Other instructions

• Keep track of your weight. Weigh yourself every day at the same time of day, on the same scale, in the same amount of clothing. A sudden increase in weight can be a sign of a problem with your heart. Tell your doctor if you suddenly gain weight, such as 3 pounds or more in 2 to 3 days.
• Do not smoke. Smoking can make it harder for you to recover. And it will raise the chances of your arteries narrowing again. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

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.

You will go to the intensive care unit (ICU) after surgery. You will probably stay in the ICU for 1 or 2 days before you go to your regular hospital room. In the ICU, you will likely have:

• Continuous monitoring of your heart.
• A tube to help with breathing for up to a few hours.
• A stomach tube that removes stomach secretions until you start to eat again.
• A tube (catheter) to drain the bladder and measure urine output.
• I.V. tubes in your arms to get fluids, nutrition, and medicine.
• A thin tube in a vein in your neck that keeps track of your heart.
• A thin tube in a blood vessel in your arm to measure blood pressure.
• Several thin wires coming out of your chest. These help keep your heartbeat steady.
• Chest tubes. These tubes drain the chest cavity of fluid and blood (which is temporary and normal) after surgery.

You will stay in the hospital for at least a few days after the surgery. You will feel tired and sore for the first few weeks. Your chest, shoulders, and upper back may ache. These symptoms usually get better in 4 to 6 weeks. It may take 1 to 2 months before your energy level is back to normal. You may have some swelling or pain in the area where the healthy blood vessel was taken.

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.

After surgery, have a heart-healthy lifestyle. This lifestyle can help lower your risk of a heart attack or stroke. It also can help the bypass last as long as possible. To have a heart-healthy lifestyle:

• Take your medicines.
• Do not smoke.
• Eat a heart-healthy diet.
• Get regular exercise.
• Stay at a healthy weight or lose weight if you need to.
• Manage other health problems such as diabetes, high blood pressure, and high cholesterol.

Smoking can make it harder for you to recover. It will raise the chances of your arteries getting narrowed or blocked again. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

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

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.

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.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take about 3 to 6 hours. This depends on the number of arteries that are bypassed and the type of surgery you have.
• You will go to the intensive care unit (ICU) right after surgery. You will probably stay in the ICU for 1 or 2 days before you go to your regular hospital room.
• You will have a breathing tube down your throat. This is usually removed within 6 hours after surgery. You will not be able to talk or drink liquids while the tube is in your throat. After the tube is removed, your throat will feel dry and scratchy. Your nurse will tell you when it is safe to drink liquids again.
• You will have a thin plastic tube, called a catheter, in a vein in your neck. It is used to keep track of how well your heart is working. This is usually removed in 1 to 3 days.
• You will also have a catheter in an artery in your arm. It is used to check your blood pressure and take blood samples.
• You will have chest tubes to drain fluid and blood after surgery. The fluid and extra blood are normal and usually last only a few days. The chest tubes are usually removed in 1 or 2 days.
• You will have several thin wires coming out of your chest near your incision. These wires can help keep your heartbeat steady after surgery. They will be removed before you go home.
• You will have a tube that drains urine from your bladder. This is called a urinary catheter. It is usually removed within 1 day.
• You may have a thin plastic tube in your nose that goes down the back of your throat into your stomach. It will drain stomach juices. It is usually removed in the days after surgery.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
• Do not smoke. Smoking can make your coronary artery disease worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

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.

Coronary artery bypass surgery is a 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. The surgery is also called bypass surgery or coronary artery bypass graft (CABG).

Your doctor will make a bypass using a piece of blood vessel from another part of your body. Your doctor will attach, or graft, this blood vessel above and below the narrowed or blocked section of your artery.

After surgery, a heart-healthy lifestyle can help you stay healthy and prevent problems. You'll also take medicines. These things help lower your risk of heart attack and stroke.

To have a heart-healthy lifestyle, eat healthy foods, get regular exercise, stay at a healthy weight, take your medicines, manage other health problems, and don't smoke.

Your doctor may suggest that you attend a cardiac rehab program. This type of program provides education and support to help you recover and prevent problems with your heart. Cardiac rehab helps you keep a heart-healthy lifestyle.

You will likely take medicines that prevent blood clots, lower cholesterol, and manage blood pressure. Along with a heart-healthy lifestyle, these medicines can help you get the most benefit from this surgery.