Coronary bypass surgery: what you need to know
If you’ve developed coronary heart disease (CHD), your doctor may have referred you to a cardiac surgeon to discuss heart surgery. For people with CHD, the most common type of surgery is a coronary bypass surgery.
During a coronary bypass surgery, blood vessels from another part of your body are used to bypass blocked arteries. This allows more blood and oxygen to flow to your heart.
While the thought of getting heart surgery can be scary, there’s good news. The success rates of coronary bypass surgery are high and choosing to get cardiac surgery now can help prevent an emergency surgery due to a heart attack later in life. If an emergency open-heart surgery is performed, there’s more risk involved.
It’s important to go into any surgery with your eyes open (not literally, of course). When you know more about the procedure and why you’re getting it, it’s easier to make educated decisions about your health. Below, you’ll find information about coronary heart disease, who is at risk for it, how a coronary bypass surgery is performed, and what recovery looks like.
What is coronary heart disease?
Coronary heart disease, or CHD, occurs when plaque — a waxy substance inside the arteries — builds up. As time goes on, the plaque can become hard, causing the coronary arteries to become narrower and reducing the flow of oxygenated blood to the heart. This build-up of plaque is known as atherosclerosis.
The plaque can also rupture, causing a blood clot to form on its surface. This is dangerous and can block blood flow through a coronary artery entirely. The ruptured plaque will eventually harden, narrowing the coronary arteries.
What causes coronary heart disease?
According to the National Institute of Health (NIH), coronary heart disease occurs when the inner layers of the coronary arteries become damaged. They can become damaged from:
- Smoking
- High levels of certain fats and cholesterol in the blood
- High blood pressure
- High levels of sugar in the blood due to insulin resistance or diabetes
- Blood vessel inflammation
Who is at risk for coronary heart disease?
Since smoking, high cholesterol, high blood pressure, and insulin resistance are all contributing factors to damaged coronary arteries, it makes sense that your lifestyle can impact your risk of developing CHD. Thankfully, these are all things that can be managed. By keeping your weight at a healthy level for your height and age, eating a healthy diet, and being physically active, you can decrease your risk.
However, there are some risk factors that you can’t control. These include:
- Older age — Men experience an increased risk for CHD beginning at age 45. Women’s risk increases around age 55. You can’t control your age but by maintaining or creating a healthy lifestyle, you can help lower your risk.
- Genetics — If your family has a history of early CHD (before age 55 for men and before age 65 for women), you may be at an increased risk of developing it, too.
Symptoms of coronary heart disease
It’s possible not to have any symptoms of coronary heart disease, called silent CHD.
The two most common symptoms of CHD are:
- Chest pain, or angina — When your heart doesn’t get enough oxygenated blood, you may feel pressure or “squeezing” in your chest. The feeling can range from mild discomfort to full-blown pain. Typically, angina gets worse with activity or emotional stress and goes away when you rest. It’s common for people to mistake angina for heartburn or indigestion. One way to differentiate is that you may feel angina in your arm, back, shoulders, neck, or jaw.
- Shortness of breath — If CHD causes heart failure, a condition where your heart can’t pump the amount of blood your body needs, you may have difficulty breathing. This is due to fluid build up in your lungs.
The Cleveland Clinic outlines other possible symptoms of CHD or a related heart problem, including:
- Pain or discomfort in the upper body including the arms, left shoulder, back, neck, jaw, or stomach
- Difficulty breathing or shortness of breath
- Sweating or “cold sweat”
- Fullness, indigestion, or choking feeling (may feel like “heartburn”)
- Nausea or vomiting
- Lightheadedness, dizziness, extreme weakness or anxiety
- Rapid or irregular heartbeats
If you experience any of these symptoms or angina (chest pain) for more than 5 minutes, you should call 9-1-1 right away. These could be indicators that you are having a heart attack, so it’s important to seek care immediately.
How does your doctor diagnose coronary heart disease?
One test can’t diagnose coronary heart disease, so your doctor will have you undergo a series of evaluations. These include:
- Your family’s history of CHD
- Your risk factors for CHD
- A physical exam
- An EKG (electrocardiogram) — a test that determines how fast your heart is beating and whether it is steady or irregular
- A chest x-ray
- Blood tests, to check the level of fats, cholesterol, proteins, and sugar in your blood
- Echocardiography — a tool that creates a moving picture of your heart using sound waves. This helps doctors to identify where there may be poor blood flow
- A stress test, where you exercise so that your doctor can evaluate possible symptoms of CHD that occur when your heart needs to pump more blood
Your doctor may not perform all of these tests. They may be able to identify (or rule out) CHD from just a couple of tests. Before having any tests done, be sure to ask your doctor any questions you have.
Who is eligible for coronary bypass surgery?
If you’re diagnosed with coronary heart disease, your doctor will decide if you’re a candidate for coronary bypass surgery based on factors like:
- The severity of CHD symptoms
- Where the blockages in your coronary arteries are and how severe they are
- How well other, non-surgical treatments for CHD work
- Your quality of life
- Your overall health
How is a coronary bypass surgery performed?
Before you go anywhere near an operating table, you should know how your surgery will be performed and who will be performing it. Having this knowledge ahead of time will give you the chance to ask any questions, as well as prepare for what’s to come.
Our partners at Scripps have created a helpful overview of how what to expect throughout this surgery:
- Before your surgery, you will get general anesthesia. You will be asleep (unconscious) and pain-free during surgery. Once you are unconscious, the heart surgeon will make an 8 to 10-inch (20.5 to 25.5 cm) surgical cut in the middle of your chest. Your breastbone will be separated to create an opening. This allows your surgeon to see your heart and aorta, the main blood vessel leading from the heart to the rest of your body.
- Most people who have coronary bypass surgery are connected to a heart-lung bypass machine, or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart and lungs while your heart is stopped for the surgery. The machine adds oxygen to your blood, moves blood through your body, and removes carbon dioxide. Another type of bypass surgery does not use the heart-lung bypass machine. The procedure is done while your heart is still beating. This is called off-pump coronary artery bypass, or OPCAB.
- Then, your doctor will create the bypass graft. He or she will take a vein or artery from another part of your body and use it to make a detour (or graft) around the blocked area in your artery:
- Your doctor may use a vein, called the saphenous vein, from your leg. To reach this vein, a surgical cut will be made along the inside of your leg, between your ankle and groin. One end of the graft will be sewn to your coronary artery. The other end will be sewn to an opening made in your aorta.
- A blood vessel in your chest, called the internal mammary artery (IMA), can also be used as the graft. One end of this artery is already connected to a branch of your aorta. The other end is attached to your coronary artery.
- Other arteries can also be used for grafts in bypass surgery. The most common one is the radial artery in your wrist.
- After the graft has been created, your breastbone will be closed with wires. These wires stay inside you. The surgical cut will be closed with stitches.
This surgery can take 4 to 6 hours. After the surgery, you will be taken to the intensive care unit.
Who performs heart surgeries?
A coronary bypass surgery is typically performed by a cardiac surgeon who has experience doing that surgery. It’s always a good idea to choose a surgeon who has experience operating on patients like you — usually, the more experience they have, the higher their success rates are (be sure to check out our guide on choosing the right surgeon).
Are there risks associated with coronary bypass surgery?
As with any surgery, there are risks of bleeding and infection during a coronary bypass. Other risks may include:
- Heart attack or stroke
- Heart rhythm problems
- Depression and mood swings
- Kidney failure
- Lung failure
- Low fever, tiredness, and chest pain, which can last up to 6 months
- Memory loss or “fuzzy thinking”
How do I prepare for coronary bypass surgery?
If you need a coronary bypass, chances are your doctor has already advised you to make some serious lifestyle changes. These might include things like eating a healthier, low cholesterol diet, quitting smoking, and getting more low-intensity exercise.
Whether or not you get the surgery, these improvements can help improve your quality of life and keep you alive and well longer.
Your surgeon and care team will give you a specific care plan to follow in the months or weeks leading up to your surgery. If you’re ever unsure about what to do, you can reach out to your Carrum Concierge for help.
Recovering from coronary bypass surgery
What happens after your surgery? Recovery, of course.
You can expect a hospital stay of between 3 and 7 days, depending on how well the surgery goes and your overall health. At least during the first night, you will be in the intensive care unit (ICU) but most people are moved to a regular hospital room the next day.
You will have to deal with breathing tubes, as well as a catheter, and tubes that drain fluid from around your heart. While uncomfortable, these are helpful and will be taken out within a day or two.
Most importantly, you’ll begin a cardiac rehab program within a few days after surgery. Your care team will send you home with instructions on what to do next. All of their recovery instructions should be followed — not doing so could result in readmission to the hospital and an unsuccessful recovery.
You should start feeling like yourself again in 4 to 6 weeks. The more you keep up with lifestyle changes like not smoking, exercising, eating a healthy diet, and managing your blood pressure, the better.
Taking care of yourself after heart surgery is critical. After all, it’s likely a combination of lifestyle choices and genetics that caused you to need surgery in the first place. Just remember that coronary bypass surgeries are incredibly effective and have relatively low mortality rates. As long as you take care of yourself after surgery, you should be able to live a long, healthy, happy life.
