When is bypass surgery recommended

Surgeons can address more than one artery in a single operation. A double bypass involves two repairs, a triple bypass involves three, and a quadruple bypass involves four. The quintuple bypass is the most intricate heart bypass surgery and includes all five of the major arteries feeding the heart. Removing a blood vessel from another part of the body will not substantially affect blood flow in the area the vessel came from. Heart bypass surgery is typically an open-heart surgery , which means that the surgeon cuts the chest open to reach the heart.

On-pump surgery involves using a heart-lung machine that circulates blood and breathes for the body. The machine allows doctors to stop the heart, which makes the operation easier. Risks and potential complications vary for each person. A doctor can help decide which treatment is the best option for each person. Before heart bypass surgery, people should:. A person undergoing a planned heart bypass operation will have an opportunity to discuss the procedure with their doctor before the operation.

The care team will explain the surgery, set up arrival times, and help complete paperwork. Many people may undergo tests before the surgery including an electrocardiogram EKG , chest X-ray, and blood tests.

The IV will allow fluids and medicines to enter the body as needed. A member of the healthcare team might also shave the areas where a surgeon will make their incisions. Immediately before the surgery, the doctors provide medicine that causes a deep sleep until after the operation. Surgeons perform hundreds of thousands of heart bypass operations each year and many of those who have the surgery get relief from their symptoms without needing long-term medication.

The more severe the heart disease , the higher the risk of complications. However, the mortality rate is low, and according to one report, only 2—3 percent of people who undergo heart bypass surgery die as a result of the operation.

After waking up, a person will have a tube down their throat that helps them to breathe. It will feel strange and uncomfortable, but it is necessary. Usually, a doctor will remove the tube after 24 hours.

On average, a person will remain in the hospital for about a week after surgery. It is normal to experience soreness and night sweats, and there is likely to be some fluid in the lungs, so people should expect a good bit of coughing. People usually start to eat and move around soon after the doctor has removed the breathing tube.

Common post-surgery medications typically include drugs called platelet inhibitors, which help prevent blood clots. Your heart doesn't just pump blood—it needs blood to survive. So, when blocked coronary arteries threaten the heart's blood supply, something must be done. Angioplasty plus stenting. A small balloon wrapped in a collapsed wire mesh stent is inserted into a blood vessel in the groin or arm and maneuvered into the heart.

When the balloon is inflated, it flattens the cholesterol-filled plaque that has been restricting blood flow through the artery. When the balloon is deflated and removed, the stent remains behind to prop open the artery. This is called balloon angioplasty with stenting. Coronary artery bypass graft CABG. During open-heart surgery, an artery or vein taken from elsewhere in the body is stitched in place to reroute blood around the blocked artery.

Which is best? It's not a toss-up. But the right choice depends on a number of factors, says Harvard revascularization expert Dr. Donald E. Cutlip says. And this question has an answer—bypass surgery—as long as the individual's surgery risk isn't too high. The heart's three coronary arteries are not all equal. The most important artery is called the left anterior descending artery LAD. It feeds blood to the whole front wall of the heart, which represents much more muscle than the area fed by either of the other two coronary arteries.

A narrowing or blockage in the LAD is more serious than narrowing or blockage in the other arteries. Bypass surgery usually is the best choice for a blocked LAD. If the LAD is not blocked, and there are no other complicating factors, stents are more likely to be used, even if both of the other arteries are blocked. One major factor is that LAD bypass uses another artery—the mammary artery, located in the chest near the heart—for the graft. Complications are rare, and CABG using the mammary artery lasts for decades.

You will stay in the hospital 3 to 8 days after the surgery. You may have some pain from the chest incision for a while. Recovery at home from surgery can take 4 to 6 weeks. Most people are able to go back to work in 1 to 2 months. You will take medicines and may need to make lifestyle changes medical therapy. Bypass surgery can relieve angina symptoms partly or completely. Surgery can help some people live longer. Whether it will help you depends on a few things, including which arteries need to be bypassed and whether you have diabetes.

Bypass surgery has short-term risks that include heart attack, stroke, kidney problems, and death. Your risk depends, in part, on your medical problems. Other risks from surgery include angina symptoms coming back, problems from anesthesia, and an infection in the chest incision. Don't have bypass surgery Don't have bypass surgery You have angioplasty and take medicines and make lifestyle changes.

Or you take medicines and make lifestyle changes. You may have angioplasty or bypass surgery later. You avoid the risks of bypass surgery. Angioplasty with medical therapy, or medical therapy alone, can relieve angina. You may still have angina. A small number of people may not live as long as they might with bypass surgery. This may depend on how bad their heart disease is.

Personal stories about coronary artery bypass surgery These stories are based on information gathered from health professionals and consumers. What matters most to you? Reasons to have bypass surgery Reasons not to have bypass surgery.

I am willing to accept the risks of surgery. I'm worried about the risks of surgery. I want more relief from my angina. I'm willing to have a surgery that has a long recovery.

I don't want to have a surgery that has a long recovery. My other important reasons: My other important reasons:. Where are you leaning now? Having coronary artery bypass surgery NOT having coronary artery bypass surgery. What else do you need to make your decision? Check the facts. Yes Sorry, that's not right.

Both angioplasty along with medical therapy and medical therapy alone can also relieve angina symptoms. Which treatment you choose depends on your overall health, how many arteries are narrowed, and where they are. It also depends on how you feel about the risks of and recovery from surgery.

No That's right. I'm not sure It may help to go back and read "Get the Facts. Bypass surgery can't cure heart disease. You will still need to take medicine and make lifestyle changes to get the most benefit from surgery.

No You're right. You will still need to take medicine and make lifestyle changes. Yes That's right. Whether it can help you live longer depends in part on your overall health and which arteries need to be bypassed. No Sorry, that's not right. Decide what's next. Yes No. I'm ready to take action. I want to discuss the options with others. I want to learn more about my options.

Use the following space to list questions, concerns, and next steps. Your Summary. Your decision Next steps. Which way you're leaning. How sure you are. Your comments. Your knowledge of the facts Key concepts that you understood. Key concepts that may need review.

Getting ready to act Patient choices. What matters to you. Print Summary. Credits and References Credits. Bravata DM, et al. Systematic review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery.

Annals of Internal Medicine, 10 : — Fihn SD, et al. Circulation, 25 : e—e DOI: Accessed October 13, Yusuf S, et al. Effect of coronary artery bypass graft surgery on survival: Overview of year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration.

Lancet, : — Shahian DM, et al. Society of Thoracic Surgeons cardiac surgery risk models: Part 1—Coronary artery bypass grafting surgery. Annals of Thoracic Surgery, 88 1 :S2—S Accessed October 16, Bucerius J, et al. Stroke after cardiac surgery: A risk factor analysis of 16, consecutive adult patients. Annals of Thoracic Surgery, 75 2 : — Accessed October 22, Get the facts Compare your options What matters most to you?

Get the Facts Your options Have coronary artery bypass surgery along with medical therapy lifestyle changes and medicines. Compare your options Have coronary artery bypass surgery Don't have bypass surgery What is usually involved? The surgery can take 3 to 6 hours. You have angioplasty and take medicines and make lifestyle changes. Check the facts 1. Yes No I'm not sure. That's right. Will bypass surgery cure your heart disease? You're right. Can bypass surgery help people live longer?

Decide what's next 1. Do you understand the options available to you? Certainty 1. Check what you need to do before you make this decision. Note: The "printer friendly" document will not contain all the information available in the online document some Information e.