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. 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 will make 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 will 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 3 to 8 days after surgery. You will probably be able to do many of your usual activities after 4 to 6 weeks. But for 2 to 3 months you will not be able to lift heavy objects or do 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.
Coronary artery bypass grafting (CABG) surgery reroutes blood around narrowed or blocked arteries, increasing blood flow to the heart muscle tissue.
The surgeon makes a vertical incision in the skin and muscle in the middle of the chest and then cuts through the breastbone (sternum).
The surgeon spreads the rib cage with a retractor to expose the heart and then cuts through the lining that protects the heart (pericardium).
To reroute blood flow around the diseased blood vessel, surgeons typically use a portion of the saphenous vein in the leg or an internal mammary artery.
Regardless of which type of blood vessel is used, oxygen-rich blood from the aorta is rerouted around the narrowed or blocked section of the coronary artery to feed the heart muscle.
After surgery, the first part of your hospital stay will include a short stay in the intensive care unit (ICU). You'll probably be there for 1 to 2 days before you go to your regular hospital room. In the ICU, you will likely have:
The amount of time you stay in the hospital varies. It will depend on your health before bypass surgery and whether complications develop from surgery.
You will stay in the hospital for at least 3 to 8 days after the surgery. You will feel tired and sore for the first few weeks. Your chest, shoulders, and upper back may ache. You may have some swelling or pain in the area where the healthy vein was taken. 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 will probably be able to do many of your usual activities after 4 to 6 weeks. But for 2 to 3 months you will not be able to lift heavy objects or do activities that strain your chest or upper arm muscles.
After surgery, you will still need to make changes in your lifestyle. This lowers your risk of a heart attack or stroke. To help the bypass last as long as possible:
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 will likely 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.
Your doctor may recommend bypass surgery if:
Your choice may depend on the number of arteries that are affected or which arteries are affected. Talk with your doctor about the best treatment for you. The best treatment for you may also depend on your age, your health, and how much your angina is affecting your quality of life.
Not everyone with coronary artery disease needs bypass surgery. Some people can be helped by angioplasty with stents. Others use medical therapy, which involves making lifestyle changes and taking medicines. Some people use both of those treatments. Your doctor is likely to recommend bypass surgery only if you will benefit from it and if those benefits are greater than the risks.
Bypass surgery can:
Bypass surgery has been done for more than 40 years. In the United States, it is one of the most common major surgeries. But it has some risks.
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.
The risks during or soon after bypass surgery include:
- Bravata DM, et al. (2007). Systematic review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Annals of Internal Medicine, 147(10): 703–716.
- Fihn SD, et al. (2012). ACCF/AHA/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 126(25): e354–e471.
- Fihn SD, et al. (2014). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. DOI: 10.1161/CIR.0000000000000095. Accessed October 13, 2014.
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