Coronary artery bypass surgery is an open-heart procedure. The person is placed under general anesthetic. The surgeon will begin the operation by making an incision down the centre of the chest, then dividing and separating the breastbone (sternum). Tubes are then attached to the heart and connected to a heart-lung machine that keeps the blood supplied with oxygen. Blood will be pumped from the heart to the machine and back to the body to be circulated again. Blood pressure, temperature, and breathing will all be regulated. It is sometimes possible to avoid cutting the breastbone by making smaller incisions in the chest.
Once the heart-lung machine has taken over for the heart, the surgeon will clamp the aorta (a major artery taking blood from the heart to the rest of the body). He or she will then graft or sew a vein or artery taken from another part of the body onto the blocked coronary artery. The grafted veins or arteries join the aorta to the coronary artery, bypassing the blocked part of the coronary artery to bring oxygen-rich blood to the heart. The vein used for the graft is usually taken from the leg (the saphenous vein).
Surgeons will often use at least one artery as a graft. This is often an internal mammary artery taken from the left or right side of the chest wall beneath the breastbone. The mammary artery is sewn directly on to the blocked coronary artery. In some cases, the mammary artery from the other side of the chest or an artery from the forearm may also be used. Both the veins and arteries used are non-essential in their original location, and their removal is not harmful.
Once the grafting is finished, the person is taken off the heart-lung machine. The heart and lungs will take over again, and the surgeon will rejoin the breastbone with stainless steel wires. As few as one and as many as 5 or 6 bypasses may be performed in a single operation.
New techniques of bypass surgery may be used in some cases. The most common method is the "beating-heart" technique. This does not use the heart-lung machine setup but still needs to be done through the incision in the middle of the chest. Bypasses are sewn directly onto the heart without stopping the heart. This reduces the risk of the complications from the heart-lung machine.
An average operation lasts from 3 to 6 hours. Patients are then monitored in an intensive care unit for at least 24 hours and may be kept sedated for their comfort. Most patients can eat solid foods after a day or two and leave the hospital in about 5 to 7 days. The stitches are removed about a week after the operation. The doctor will often recommend an exercise program to help the healing process and to ease the return to previous levels of activity and return to work.
After surgery, all patients will need to continue taking medications that decrease the work of the heart and reduce the risk of future heart attacks. The medications usually prescribed are acetylsalicylic acid (ASA)* to prevent blood clots, beta-blockers, cholesterol-lowering medications such as the statins, and ACE inhibitors (medications that control blood pressure). Artery grafts rarely go on to develop CAD. More than 80% still work 10 years after the surgery. Vein grafts more often become obstructed. After 5 years, one-quarter of any vein grafts may be clogged.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
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