Coronary arteries are blood vessels that carry oxygen and nutrients to the heart. Coronary artery bypass surgery is an operation to improve the flow of blood to the heart muscle when your coronary arteries are severely narrowed or blocked by plaque. Plaque is a buildup of fats, cholesterol, and other substances on the inside walls of the arteries.
The operation involves taking blood vessels from other parts of your body and attaching them to the coronary arteries beyond the blockage. The blood is then able to flow around, or bypass, the blockages. If more than one artery is blocked, you may need more than one bypass.
The location and degree of coronary artery blockages are mapped before surgery using a procedure called heart catheterization, or coronary angiogram.
Coronary artery bypass surgery is performed by a team of surgeons. The operation takes 2 to 6 hours, depending on how many blood vessels need to be bypassed. Your surgeon will make a cut in your chest and divide your sternum (breastbone). He or she will connect you to a heart-lung machine that will take over the work of your heart and lungs during the operation.
If a vein is used for the bypass, one end of it is sewn into the aorta (the main artery from the heart to the body). The other end is sewn into the area below the blockage in the coronary artery. If the mammary artery is used, the lower end of the mammary artery is cut and reattached to the coronary artery beyond the blockage. In either case, the blood then uses the new vessel as a detour to bypass the blockage.
The doctor will then close the cut in your heart and restart your heart. He or she will take you off the heart lung machine and close the cut in your chest by wiring together your sternum (breastbone) and then close the skin with stitches. The doctor may leave some tubes in the cut to drain any blood or fluid.
If the blocked coronary arteries are on the front side of the heart, it may be possible for the surgeon to do the bypass through a small incision in the upper chest. This approach does not require cutting the breastbone and makes recovery much easier, but it is not appropriate for most people. Check with your doctor to see if this approach will work for you.
After surgery, you will go to the intensive care unit (ICU). You will stay in the ICU overnight or as long as you need for observation. A constant electrocardiogram (ECG) monitor will record the rhythm of your heart.
You will have respiratory therapy to prevent any lung problems, such as a collapsed lung, infection, or pneumonia. A nurse or therapist will give you a breathing treatment every few hours. Ask for pain medicine if you need it. You will have physical therapy, which includes walking around the hospital and other strengthening activities. You will learn how to move your upper arms without hurting your breastbone. You will be told which foods to avoid when you get home, such as foods high in fat, cholesterol, and sodium.
Article: Puxiao Cen, M.D.