The surgeon uses a blood vessel from another part of your body to make a new channel so blood can flow around the blocked area of your artery or arteries. (Don't worry: Removing arteries and veins won't significantly affect the blood flow from where they're taken.)
The blood vessel that will bypass your blockage comes from one of three places:
1. The chest wall
An artery from inside the rib cage can be detached. The surgeon will sew the open end to the coronary artery below the blocked area.
2. The leg
A section of a long leg vein can be removed. One end is sewn onto the large artery that leaves the heart (the aorta). The other end is attached to the coronary artery below the blocked area.
3. The arm
A section of the radial artery in the forearm can be removed — as long as the ulnar artery (the other artery in the forearm) is functioning normally. One end is sewn onto the aorta. The other end is attached to the coronary artery below the blocked area.
Before the operation:
Much of your body hair will be shaved, especially from your chest and legs.
You'll shower and wash with antiseptic soap to remove bacteria from your skin and reduce the chance of infection.
You'll be asked to give personal items, such as glasses, contact lenses, jewelry and dentures, to a family member for safekeeping.
About an hour before surgery, you'll receive medications to relax you and make you drowsy.
You'll be wheeled into the operating room and receive anesthesia to put you to sleep.
During the operation, the surgeon will usually connect you to a heart-lung machine. This machine controls your lungs and heart. It adds oxygen to your blood and circulates the blood throughout your body. The machine makes it possible for the surgeon to stop your heart from beating while he or she sews the new blood vessel in place.
The main steps of bypass surgery:
Open the chest to reach the heart
Remove the veins or arteries from the leg and/or arms that are needed for the operation
Put the patient on the heart-lung machine and stop the heart with a solution that contains a large amount of potassium
Perform the surgery
Restart the heart (with an electric shock, if necessary) and disconnect the heart-lung machine
Check, clean and close the surgical area
The surgery can take three to six hours. The time spent on the heart-lung bypass machine and making the bypass is much less — usually under an hour. The length of time depends on what has to be done. Each operation varies in complexity.
You may hear about several new techniques for bypass surgery. Port-access coronary bypass and minimally invasive coronary artery bypass are considered minimally invasive surgeries. This means they don't involve opening the chest to the same degree that standard bypass surgery does. (This type of surgery is also called limited-access coronary artery surgery.) Another technique, called off-pump bypass surgery, is performed without stopping the heart. The goal of all these newer techniques is to decrease complications and/or pain.
Port-Access Coronary Artery Bypass
You're placed on a heart-lung machine and your heart is stopped, just as it is during regular bypass surgery. But in this procedure, small incisions (called ports) are made in your chest, rather than cutting open the entire chest. The surgical team inserts instruments through the ports to perform the bypass. The team watches what is going on inside your chest on video monitors.
Minimally Invasive Coronary Artery Bypass
The goal of this technique is to avoid using the heart-lung machine. Instead, your heart continues to beat while the surgery is performed. This procedure also uses small ports in your chest, as well as a small incision directly over the coronary artery that needs to be bypassed. The surgeon can see the artery through this incision.
Off-Pump Coronary Artery Bypass
In this operation, the heart is never stopped. Special equipment holds the area of the heart on which the surgeon is working as still as possible. This technique is aimed at reducing complications, such as stroke, from using the heart-lung machine.