Bypass Surgery

What is bypass surgery (Coronary Artery Bypass Grafting, CABG) ?

Cardiovascular disease is the leading cause of death in the United States.  Coronary artery bypass grafting (CABG) is one of the most commonly performed major operations in the United States.  Currently about 500,000 bypass operations are done annually in the United States.

If there are blockages in the coronary arteries, treatment options include medications, percutaneous coronary intervention (stents), and bypass surgery.  Your cardiologist will recommend bypass surgery when your coronary artery disease  cannot be safely treated with medications or angioplasty (percutaneous coronary intervention). Your cardiologist will only recommend a bypass operation when the other options cannot keep you healthy – for those people a bypass operation can be life saving.

During a bypass operation the cardiothoracic surgeon will often make an incision in the center of the chest, called a median sternotomy, although minimally invasive operations can de done in special circumstances.  Veins are taken from the leg and are used to bypass the blockages in your own coronary arteries. The left internal mammary artery (LIMA) is an artery that runs on the inside of the chest wall. When the LIMA is used during a bypass operation it stays open longer than the vein grafts. Today most CABG operations are performed using a combination of vein grafts and the LIMA graft. Arteries from other locations can sometimes also be used to perform the bypass.

What are the risks of bypass surgery?

As with any surgical procedure there are risks that you need to be aware of prior to the operation. Your cardiologist and cardiothoracic surgeon would not recommend open heart surgery unless it is their judgement that the benefits outweigh the risks.

The risk of death with bypass surgery for all people referred is less than 3%. For many patients the risk is less than this, as this number takes into account even the very sickest patients referred for heart surgery. Some of the other possible complications include myocardial infarction, stroke, atrial fibrillation, congestive heart failure, infection , bleeding, kidney failure, and respiratory failure.

What are the benefits of bypass surgery?

If you need bypass surgery it is because there are severe blockages in the arteries that supply blood to the heart. Bypass surgery is the most comprehensive way to restore normal blood flow to the heart if there are multiple areas of blockage. Patients and their families should feel free to ask the cardiologist and the cardiothoracic surgeon about alternatives to surgery. After recovering from the operation most patients feel better, often not realizing how much they had slowed down prior to their surgery.  If there is decreased pumping function of the heart restoring normal blood supply may lead to an improvement in the heart’s function. Most importantly, bypass surgery can be life-saving so that you may continue to enjoy both a better quality and quantity of life.

After your operation you will need to continue to see your cardiologist regularly to make sure your blood pressure and cholesterol are under good control.  Your cardiologist may order tests to monitor your heart’s function after surgery such as a stress test or echocardiogram.  Bypass surgery restores blood supply to the heart, but it is not a cure, so you need to continue to live a healthy lifestyle and understand that you will need to continue to take medications to prevent future cardiovascular problems.