Coronary Artery Bypass Surgery

Coronary bypass surgery is one of the most important operations performed by cardiothoracic surgeons to enable the heart muscle to obtain the necessary oxygen by making a bypass from other arteries obtained from other parts of the body (arm, leg or chest) to repair the defect caused by blockage or severe narrowing of coronary arteries heading towards the heart.

Coronary bypass surgery is one of the most important operations used by cardiothoracic surgeons to avoid heart failure; therefore, it may be performed in emergent and urgent conditions when other methods such as medication or coronary artery catheterization have failed to open the blocked arteries.

After waking from a heart bypass surgery, the patient will have a tube in their throat.  There may also be incisional pain as the sternum usually needs to be fractured in order to have access to the heart for the procedure.

Some side effects from having the bypass surgery include difficulty remembering the time, confusion, and short term memory loss.  These side effects are usually temporary and will go away by the time the patient leaves the hospital after the procedure.

After the surgery, the patient can be expected to be in the ICU (intensive care unit) for 1-2 days.  During this time, the patient’s vital signs are frequently performed and the heart is monitored on an EKG tracing until the time of discharge. After a short stay in the intensive care unit, the patient is usually sent to patients` rooms in the hospital where they will begin having cardiac rehabilitation as an inpatient.  The average hospital stay after a bypass surgery is about 7 days.

Before leaving the hospital, the surgeon and the rest of the surgical team will provide the patient with complete discharge instructions as to how to care for themselves.  This might include instructions to refrain from physical activity (besides that allowed in cardiac rehab), to get as much rest as possible, and instructions as to how to care for the incision. 

The accumulation of plaques or fats droplets on the inner walls of the coronary arteries causes blockage or narrowing them (atherosclerosis), which may significantly weaken blood flow to the heart muscle which is required to deliver oxygen, and therefore the tendency to undergo coronary bypass surgery to maintain heart muscle.

Cardiac and thoracic surgeons often make the decision to undergo coronary bypass surgery after the failure of medications to repair the defect, and the coronary catheterization may fail to open the blocked arteries. Sometimes, surgery may be performed in emergent conditions after heart attack.

Coronary bypass surgery may be performed on an emergent way, then the patient is prepared quickly and is also informed of all instructions and precautions, but in normal cases where the patient is informed in advance of the date of the operation, a set of preparations and procedures under the supervision of the cardiothoracic surgeon should be followed to ensure that the patient is fully prepared for the operation, including:

• Examining the patient's health in general and know the family medical history of heart diseases in particular.
• Many physical examinations, including a comprehensive cardiac assessment.
• Electrocardiogram (EKG).
• X-ray scan for chest; to check heart size and assess lung efficiency.
• Blood tests.
• Coronary angiography.
• Cardiac stress test.

Coronary bypass surgery may have some risks and complications, including:

• Bleeding.
• Irregular heartbeat.
• Inflammations or infections through the incision in the chest.
• Kidney disorders.
• Stroke.
• Memory and thinking problems, which may last from six to 12 months.
• Heart attack.

• Stop smoking for about two weeks before the operation; to help quick healing of wounds.
• Stop any medications that may cause blood clots, such as aspirin or warfarin.
• Stop using painkillers; because they can interfere with the process of blood clotting in the body.
• Try to stay away from all causes of infection, such as the flu or cold symptoms that can lead to the postponement of the coronary bypass surgery.

This surgery consists of three stages:

• Preparation of the patient for surgery:

1. The patient should shower with antiseptic soap a day before the surgery; to reduce the chances of infection and to keep the body clean.
2. Refrain from the food and drink from the middle of the night before the day of surgery.
3. Shaving the chest at the site of incision.
4. Placing cannula into one of arm veins; to provide the patient with needed fluids.

• During the surgery:

The patient receives general anesthesia, then a tube is inserted through the mouth for breathing, which is connected to ventilator that ensures natural entrance of oxygen to the body during and immediately after the surgery.

The cardiothoracic surgeon begins to make a long incision across the chest by cutting the sternum (breastbone) in half, and the patient stays connected with the heart-lung machine to maintain flowing of blood and oxygen through organs and tissues.

After making an incision, the rib cage opened for easy and clear access to the heart. The heart is then stopped temporarily and the body is connected directly to heart-lung machine to ensure continuous circulation of the blood.

The heart and chest surgeon then installs a section of arteries (vessels of the inner wall of the chest or from the leg) taken from another part of the body, so that these new arterial connections are connected above and below the blocked area of the coronary artery, thus changing the bloodstream to bypass the blocked area and moves through the new bypass.

The surgeon then restores the heart to work again and checks for heartbeat, and disconnects the patient from heart-lung machine, then restoring the rib cage to its normal position and closing it by using a specific wire.

• After the surgery

The patient is then moved to the intensive care unit to monitor the vital processes within his body and ensure the performance of each organ of its function, in addition, the medical team have to check on the heart and to verify its ability to function properly by connect the patient with an electrocardiogram.

The patient is then sent to the cardiac care unit (CCU), where he receives the necessary treatment through cardiac rehabilitation as an inpatient in the hospital.

After coronary bypass surgery, the patient often feels some pain caused by cutting the sternum, as well as feeling unable to remember anything, along with confusion, which will be disappeared in a very short time once the patient is recovered and go out from hospital.

Because of the seriousness and sensitivity of such operations, the first thing that is recommended to the patient after the surgery is the need to follow the instructions of the cardiothoracic surgeon and the medical team as a whole in relation to the new lifestyle, the type of sports activities that the patient can practice, and the drugs that should be taken or avoided, sometimes, the patient may need to take blood thinners for the rest of his life.

The patient may suffer from night sweats and fluid build-up in the lungs which result in cough for a short time.

Recovery from coronary bypass surgery usually takes about 6 to 12 weeks, preferable to spent by having total rest, during this period; the patient can practice cardiac rehabilitation and allow the wound in the sternum to heal.

The patient should remain vigilant with regard to any emergency symptoms; for example, if redness or any discharge from the chest at the site of incision, accelerated or irregular heartbeat and body temperature exceeding 38 degrees, the heart and chest surgeon should be called as soon as possible.