Stethoscope on the Cardiogram

Bypass Surgery

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Coronary bypass surgery redirects blood around a section of a blocked or partially blocked artery in the heart. The procedure involves taking a healthy blood vessel from leg, arm or chest and connecting it below and above the blocked arteries in heart. With a new pathway, blood flow to the heart muscle improves.

Coronary bypass surgery doesn't cure the heart disease that caused the blockages, such as atherosclerosis or coronary artery disease. However, it can ease symptoms, such as chest pain and shortness of breath. For some people, this procedure can improve heart function and reduce the risk of dying of heart disease.

The patient and doctor might consider it if:

  • The patient has severe chest pain caused by narrowing of several arteries that supply heart muscle, leaving the muscle short of blood during even light exercise or at rest.

  • The patient have more than one diseased coronary artery, and the heart's main pumping chamber — the left ventricle — isn't functioning well.

  • The left main coronary artery is severely narrowed or blocked. This artery supplies most of the blood to the left ventricle.

  • You have an artery blockage that can't be treated with a procedure that involves temporarily inserting and inflating a tiny balloon to widen the artery (angioplasty).

  • You've had a previous angioplasty or placement of a small wire mesh tube (stent) to hold the artery open that hasn't been successful. Or you've had a stent placement, but the artery has narrowed again.

Procedure

Coronary bypass surgery generally takes between three and six hours and requires general anesthesia. The number of bypasses the patient need depends on where in heart and how severe blockages are.

For general anesthesia, a breathing tube is inserted through mouth. This tube attaches to a ventilator, which breathes during and immediately after the surgery.

Most coronary bypass surgeries are done through a long incision in the chest while a heart-lung machine keeps blood and oxygen flowing through body. This is called on-pump coronary bypass surgery.

The surgeon cuts down the center of the chest along the breastbone and spreads open the rib cage to expose the heart. After the chest is opened, the heart is temporarily stopped with medication and a heart-lung machine takes over to circulate blood to the body.

The surgeon takes a section of healthy blood vessel, often from inside the chest wall or from the lower leg, and attaches the ends above and below the blocked artery so that blood flow is redirected around the narrowed part of the diseased artery.