Coronary Artery Bypass Surgery

If one or more of your coronary arteries (the vessels that carry blood to your heart muscle) are blocked, blood can’t flow to the heart muscle. In this case, the heart muscle may die (heart attack) or become weakened and damaged and cause chest pain (angina). Problems like shortness of breath, increasing fatigue, leg swelling, or feeling rundown may occur. Coronary artery bypass surgery creates a path for blood to flow around a blockage and helps reduce the risk for further damage to your heart from lack of sufficient blood flow.

Preparing the Bypass Graft

First, a healthy blood vessel (graft) is taken from another part of the body. Taking this graft usually doesn't affect blood flow in that body part. If you have more than one blockage, which is often the case,more than one graft may be needed. One or more of these blood vessels will be used for the graft:

  • The saphenous vein, which is located in the leg.

  • The radial artery, which is located by the wrist.

  • The internal thoracic (mammary) arteries, which are located in the chest wall. There are two internal thoracic arteries, one on each side of the chest. Typically, the left on is used, but sometimes both are used.

Reaching the Heart

While one member of the bypass team is harvesting the graft(s), another member works to expose your heart. First, an incision is made in the chest. Then the breastbone (sternum) is opened down the middle and then pulled apart. The breastbone is held open throughout surgery. This puts pressure on the nerves of the chest. This is why you may have soreness and muscle spasms in your chest, shoulders, and back during recovery.

Image of heart

Attaching the Graft

A small opening is made in the coronary artery, past the blockage.

  • If a saphenous vein or radial artery is used, one end of the graft is sewn onto this opening. The other end is typically sewn on to the aorta. The diseased artery is not removed. If a stent is present, it is not removed either, as will have grown into the artery already.

  • If the internal thoracic (mammary) artery is used, one end of the graft is sewn onto this opening. The other end is already attached to a branch of the aorta.

The end of the graft is sewn into a small opening made past the blockage on the coronary artery.Heart showing internal thoracic (mammary) artery graft and the grafted veins.

Finishing Up

Once the graft has been attached, blood will start flowing through this new pathway to bypass the blockage. If you have multiple blockages, more than one bypass may be done. Then your breastbone is rejoined with wires. These wires will stay in your chest permanently. Rarely do they cause a problem, and they are safe around microwaves and airport metal detectors. The incision is closed, and you are taken to the intensive care unit to begin your recovery.

Using a Heart-Lung Machine

Coronary artery bypass surgery can be done with the heart still beating (off pump) or with the heart still (on pump.) Your surgery team can tell you more about which type of procedure you will have.

  • On-pump procedure. A machine does the work of your heart and lungs during surgery. Blood is circulated through a heart-lung machine. The machine supplies the blood with oxygen and pumps it back through the body. In these cases, the heart may be stopped temporarily before the graft is attached. Your own heart and lungs start working again after the bypass is completed.

  • Off-pump procedure. The heart-lung machine is not used and the heart is not stopped. This is sometimes called a "beating heart" procedure.

There are advantages and disadvantages to each technique. If you have a question about why your doctor is using one technique, instead of the other, do not be afraid to ask.

 

Risks and Complications

You and your surgeon can discuss the risks and possible complications of coronary artery bypass surgery. They may include:

  • Excessive bleeding, sometimes requiring a transfuion or a trip back to the operating room

  • Infection of the incision sites

  • Pneumonia (lung infection)

  • Fast or irregular heartbeat, which is almost always temporary 

  • Nerve injury or muscle spasms

  • Breathing problems

  • Memory problems or confusion

  • Heart attack, stroke, or death

  • Damage to other parts or organs of your body due to problems with blood circulation

Online Medical Reviewer: Foster, Sarah, RN, MPH
Online Medical Reviewer: newMentor board-certified, academically affiliated clinician
Last Review Date: 2/19/2013
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