Your doctor may recommend heart bypass surgery to reduce your risk of heart attack when angioplasty and stenting are not an option. Angioplasty and stenting are less invasive procedures that can treat certain types of narrowed or blocked coronary arteries. Your doctor will base the decision to perform a heart bypass on:
- Your symptoms, especially severe symptoms of coronary artery disease. This includes angina and shortness of breath. Angina is chest pain or discomfort.
- The location of your blockage or blockages
- The number of blockages you have
- The severity of your blockage or blockages
Who performs heart bypass surgery?
A cardiac surgeon performs heart bypass surgery. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. A cardiac surgeon may also be known as a cardiothoracic surgeon.
How is heart bypass surgery performed?
Your heart bypass surgery will be performed in a hospital using one of the following approaches:
- Minimally invasive coronary artery bypass (MIDCAB) is performed through a small (three to five inch) incision between your ribs. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.
- Port access coronary artery bypass surgery involves inserting special instruments and a thoracoscope through ports or very small incisions in your chest. A thoracoscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your chest to a video screen viewed by the surgeon while performing surgery.
- Open heart coronary artery bypass surgery involves making a large (six to 10 inch) incision in the chest and through the breastbone (sternum). An open surgery incision allows your surgeon to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different heart bypass surgery procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform heart bypass surgery using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
What to expect the day of your heart bypass surgery
The day of your surgery, you can generally expect to:
- Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
- Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
- Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
- A surgical team member will start an IV.
- The anesthesiologist or nurse anesthetist will start your anesthesia.
- A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
- The surgical team will monitor your vital signs and other critical body functions. This occurs throughout surgery and your recovery until you are alert, breathing effectively, and vital signs are stable.