Focus on: Heart bypass surgery

Coronary Artery Bypass Grafting illustration

Heart bypass surgery can help relieve the symptoms of angina and improve quality of life. Doireann Maddock talks to Professor Gavin Murphy about what’s involved.

Coronary artery bypass grafting, often referred to as heart bypass or grafts, is a common surgical procedure and a relatively routine treatment for coronary heart disease (CHD). Most people make a full recovery within 12 weeks, although it varies between individuals, but as with any operation, it can be a daunting prospect. Professor Gavin Murphy answers some frequently asked questions.

What is heart bypass?

It’s a surgical procedure to treat CHD, which is when the arteries that supply your heart muscle with oxygen-rich blood (the coronary arteries) become narrowed by a gradual build-up of fatty material (atheroma) within their walls. It involves taking a healthy blood vessel from another part of the body – usually the chest, leg or arm – and using it to bypass the blocked or narrowed coronary artery.

The new blood vessel is called a graft, and it helps to reroute blood around the narrowed part of the artery, which improves the supply of blood and oxygen to the heart muscle.

Why is it done?

The heart needs a constant supply of oxygen-rich blood to survive, and this is supplied by blood vessels called coronary arteries, located on the outside of the heart. The heart has three major coronary arteries: two of these arise from the left main coronary artery, which then branches into two; and the other major artery is called the right coronary artery. Over time, fatty deposits can build up on the inside of these arteries, causing CHD and reducing blood flow to the heart. When this happens, you can develop symptoms such as chest pain – angina – and you may become short of breath. You are also more at risk of a heart attack.

Heart bypass is safer than ever

You’re said to have single-, double-, or triple-artery disease depending on the number of coronary arteries that are narrowed. For some people, CHD can be managed with just medication and lifestyle changes. For those whose arteries are more extensively affected, heart bypass can be an option. Heart bypass is done to improve the symptoms of CHD and help reduce the chances of having a heart attack.

What are the risks?

Heart bypass is safer than ever, but as with all operations, there are risks, and any operation puts the body under stress. The risk of developing complications depends on a number of things, including your health before the surgery. About one in 10 people will experience significant memory loss after surgery, but the vast majority affected will fully recover from this. Reduced kidney function also happens in about one in three people and usually resolves in the days following surgery. Major complications, such as stroke, carry a general risk of one to two per cent. Your doctor can advise you on your risk as an individual.

What happens during heart bypass?

On average, heart bypass takes about three and a half hours. The surgeon needs to access the heart, and in the traditional heart surgery technique, this involves cutting the breastbone. It’s also possible to access the heart using a smaller incision that is made directly over the area where the artery is affected, but this technique is not suitable for all patients.

Next, blood vessels are removed from the legs and/or arms and prepared to provide the new grafts. Other blood vessels in the area are able to compensate for the ones that are removed.

Most people find that it takes between two and three months to make a full recovery

In most cases, the heart is then stopped and the blood is diverted to a heart-lung machine that takes over the pumping function. In ‘off-pump’ or ‘beating heart’ surgery, the heart-lung machine is not required, because the surgery is performed without stopping the heart. The choice of technique depends on the individual surgeon, but excellent results are achieved with both.

After the heart has been stopped (or while it is still beating, if during ‘off-pump’ surgery), the prepared grafts will be used to bypass the narrowed areas in your coronary arteries.

Once the narrowed arteries have been bypassed, the heart will be restarted and the blood will slowly be allowed to re-enter the heart from the heart-lung machine. Once the heart has taken over pumping, the heart-lung machine is turned off.

When the surgeon is satisfied that the operation is complete, the breastbone is securely closed using wires that will stay in place permanently. Sutures are then used to close the skin on the chest and on any cuts made to remove blood vessels.

What happens afterwards?

The average stay in hospital after heart bypass is six nights and usually consists of about one night in intensive care, one night in the high dependency unit and about four nights on the ward. Most people are well enough to sit in a chair after one day, walk after three days and walk up and down stairs after five or six days. After a big operation such as heart bypass, it’s normal to feel tired, emotional and uncomfortable. The amount of discomfort varies from person to person, and medication can be given to help.

How long does it take to recover from bypass surgery?

This varies from person to person, but most people find that it takes between two and three months to make a full recovery. People over the age of 80 may find recovery takes longer; it’s not unusual for it to take six months to a year to derive the full benefits.

What happens when people go home?

People who attend cardiac rehabilitation are more likely to get the full benefits of their surgery

For the first two or three days at home, people should try to do about the same amount of moving around and walking exercise as they did with the physiotherapist during their last couple of days in hospital. After a few days, it’s OK to slowly increase activity levels. Walking is ideal, but before leaving hospital, it’s good to ask the medical team how much activity is appropriate and what the safest way to increase it is.

Wound infections can sometimes occur nine to 10 days after surgery. Signs of a possible infection can include the wound becoming more painful or looking red, inflamed or swollen. If this happens, you should contact the medical team involved in the operation. Wound infections can usually be treated successfully with antibiotics if they are diagnosed early.

How important is cardiac rehabilitation?

It’s absolutely fundamental. The hospital where you’ve been treated should invite you to go on a cardiac rehabilitation programme, and this usually starts around six weeks after you leave hospital. People who attend cardiac rehabilitation are more likely to get the full benefits of their surgery, have a better quality of life and have fewer hospital admissions.

How long do bypass grafts last?

People tend to do very well after heart bypass and most get a good 15 years before needing another intervention, which at that point would almost always be having a stent inserted. Redoing heart bypass could also be an option if stenting weren’t suitable. It’s important to remember that heart bypass doesn’t cure the underlying CHD, so look after your heart health by following the lifestyle advice that’s been recommended and continue taking any prescribed medication.

Professor Gavin MurphyProfessor Gavin Murphy

Professor Murphy is BHF Professor of Cardiac Surgery at the University of Leicester, combining heart research with skilled cardiac surgery to reduce the threat of organ failure after a heart operation.

Support from the BHF

For more information on heart bypass, call our Heart Matters Helpline on 0300 330 3300 to speak to a cardiac nurse or heart health adviser.

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