What Is Bypass Surgery?

More than 900,000 cardiac surgeries, including coronary bypass surgeries, are performed the U.S. every year, with even more taking place throughout the world. Cardiac surgery is performed on the heart and its large blood vessels, including the pulmonary arteries and the aorta.

Cardiac surgery is a powerful tool in the treatment of heart disease, including:

• Coronary artery disease
• Heart valve repair or replacement
• Heart failure
• Congenital heart defects. These are heart defects that are present at birth.

“Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States,” says Thor Sundt, MD. Dr. Sundt is director of the cardiac surgery clinical service at Mass General Brigham and a cardiac surgeon who cares for patients at Massachusetts General Hospital.

In this article, he discusses what patients can expect from coronary bypass surgery and recovery.

What is coronary bypass surgery?

One of the most common heart conditions is coronary artery disease, which is often treated with coronary bypass surgery.

“The coronary arteries are the arteries on the heart that supply blood to the heart itself. When those arteries become blocked, the heart can’t get enough oxygen and you can have a heart attack,” explains Dr. Sundt. The arteries become clogged with a substance called plaque, which is made up of fat, cholesterol, and other materials.

In coronary bypass surgery, surgeons take a healthy blood vessel from elsewhere in the body, and use it to create a new pathway for blood to flow around the blocked artery. The surgeons choose the new blood vessel carefully so that the benefits of the procedure last a long time. Dr. Sundt explains, “Our goal is to use as many arterial grafts (arteries from the chest) as possible as opposed to veins from the leg. For younger patients particularly, we try to get as close as possible to complete arterial grafting.”

“Coronary bypass surgery won't prevent heart attacks 100 percent, but it's been shown to reduce the risk and can make you live longer,” says Dr. Sundt. These risks are reduced even further if patients follow good lifestyle habits after surgery, like quitting smoking, reducing their cholesterol, and exercising regularly.

Coronary artery disease risk factors and symptoms

About half of Americans have at least 1 of the 3 key risk factors for heart disease:

• High blood pressure
• High cholesterol
• Smoking

For some people, the first symptom of coronary artery disease can be a heart attack. “If you do have a symptom, the most common one is chest pain or angina pectoris, which is tightness and pressure in the heart, chest, or arm. It may happen with exertion, and doesn’t feel like a typical pain,” says Dr. Sundt.

If you do feel any concerning symptoms in your chest or arm, or have a family history of heart disease, be sure to let your primary care provider (PCP) know. They might refer you to a cardiologist for specialty care.

Coronary artery disease may not show up on electrocardiograms (EKGs), which are tests that measure the heart’s electrical activity. “It can also be hard for some people to believe that they need an operation when they’ve not had any symptoms. That’s why I always show patients their actual angiogram, a scan which shows blood flow through the arteries, where you can see the blockages,” Dr. Sundt says.

Before bypass surgery

Your cardiologist and cardiac surgery team works together with you to develop a plan for your procedure. Your providers may order additional tests before your surgery, including:

• X-rays
• EKG
• Blood work

Your doctors may also have suggestions about adjusting your lifestyle to reduce the risks of surgery. “If you smoke, quit smoking. If you have diabetes, make sure it’s under good control,” says Dr. Sundt as an example.

After bypass surgery

After surgery, patients will stay in the hospital for a little less than a week. Dr. Sundt notes, “Some patients may need to go to an inpatient rehabilitation facility prior to going home. Ultimately, your doctor wants to set you up for recovery success after having such a major surgery.”

“Once the bones have healed, there’s no limitation to your activities,” says Dr. Sundt, as long as you clear things with your doctor first. This includes sexual activity. “People can be crippled by fear of future heart issues, but the truth is it’s very important for patients to know that after heart surgery you can go back to living a full normal life, including an active romantic life,” he says.