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Hybrid Coronary Bypass

By

Sarah Lewis, PharmD

What is hybrid coronary bypass?

Hybrid coronary bypass is surgery that combines minimally invasive robot-assisted bypass with coronary angioplasty and stenting. Your surgeon may recommend this surgery if you have a major blockage in the left anterior descending (LAD) coronary artery and smaller blockages in other coronary arteries. Some hospitals are equipped to provide both procedures at the same time, while others provide the procedures in two stages.

Your coronary arteries are the vessels that supply the heart muscle with blood. Bypass surgery uses a graft to create a new route for blood to flow around a narrowed or blocked coronary artery. A graft is a healthy vessel taken from other places in your body.

Coronary angioplasty widens or opens a blocked or narrowed coronary artery. Stenting involves inserting a mesh tube inside your coronary artery and expanding it to keep it open after angioplasty. Stents remain in place to keep your coronary artery open.

Hybrid coronary bypass is major surgery that has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having hybrid coronary bypass. 

Why is hybrid coronary bypass performed? 

Your surgeon may recommend this surgery if you have a major blockage in the left anterior descending (LAD) coronary artery, along with other non-LAD partial blockages. Your doctor will only consider hybrid coronary bypass if less invasive treatments are ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion.

Your doctor may recommend hybrid coronary bypass under the following conditions: 

  • You have multi-vessel blockages with a major blockage of the LAD and partial blockages in other vessels.

  • Your LAD blockage is graftable and the other vessel blockages are candidates for angioplasty.

  • You would benefit from a minimally invasive procedure over a traditional open-heart surgery.

  • You have not had previous heart or chest surgery, are not obese, do not have poor lung function, and are not in an emergency situation. 

Who performs hybrid coronary bypass?

A cardiac surgeon and an interventional cardiologist often work as a team to perform hybrid coronary bypass. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons. Interventional cardiologists specialize in diagnosing and treating heart disease using catheter procedures and radiological imaging.

How is hybrid coronary bypass performed?

Your doctors will perform your hybrid coronary bypass in a hospital. The bypass portion of the surgery treats the more seriously blocked coronary artery. It involves making four or five tiny porthole incisions between your ribs. Your cardiac surgeon will use a robot and insert special instruments and a thoracoscope through these very small incisions in your chest. 

A thoracoscope is a thin, lighted instrument with a small camera. The camera sends pictures of the inside of your body to a video screen viewed by the surgeon while performing surgery. This part of the surgery involves placing a graft to create a new route for blood to flow around the narrowed or blocked coronary artery.

The coronary angioplasty and stenting portion of the surgery treats less seriously blocked or narrowed coronary arteries. It involves inserting a catheter and guide wire through an incision in your groin. The doctor feeds the catheter into the coronary artery that needs angioplasty. X-rays help guide the wire to the exact location.

Your doctor will inject a contrast agent through the catheter to help improve the quality of the X-ray images. Still using X-ray guidance, your doctor will open or widen your artery and place a stent to keep it open.

Types of anesthesia 

Your doctors will perform your hybrid coronary bypass 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 surgery and do not feel any pain.

What to expect the day of your hybrid coronary bypass

The day of your surgery, you can 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. The surgical 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 may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of hybrid coronary bypass?  

As with all surgeries, hybrid coronary bypass involves risks and complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery. 

General risks of surgery 

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock

  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.

  • Infection and septicemia, which is the spread of a local infection to the blood

Potential complications of hybrid coronary bypass

Complications of hybrid coronary bypass include:

  • Damage to an artery from the catheter or balloon

  • Death

  • Heart attack

  • Heart arrhythmias or problems with heart rhythm

  • Kidney or lung failure

  • Recurrence of artery narrowing or blockage

  • Stroke

  • Sudden vessel occlusion. This is a total blockage of the artery at the site of the angioplasty. Sudden vessel occlusion is a rare complication that typically occurs within 24 hours of angioplasty. It requires immediate medical attention.

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan including:

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes cardiac rehabilitation.

  • Informing your doctor if you are nursing or there is any possibility that you may be pregnant

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage 

  • Taking your medications exactly as directed 

  • Telling all members of your care team if you have any allergies

How do I prepare for my hybrid coronary bypass? 

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for a hybrid coronary bypass by:

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.

  • Following dietary guidelines as directed

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments. 

It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:

  • Why do I need a hybrid coronary bypass? Are there any other options for treating my condition?

  • How many of these procedures have you performed? What were the outcomes?

  • How long will the surgery take? When can I go home?

  • What restrictions will I have after the surgery? When can I return to work and other activities?

  • When will I start cardiac rehabilitation? Where do I go for it? 

  • What kind of assistance will I need at home?

  • What medications will I need before and after the surgery? How should I take my medications?

  • How will you treat my pain?

  • When should I follow up with you? 

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my hybrid coronary bypass?

Knowing what to expect can help make your road to recovery after hybrid coronary bypass as smooth as possible. 

How long will it take to recover?

You will stay briefly in the recovery room until your vital signs are stable. Your care team will then move you to an intensive care unit (ICU). ICUs provide 24-hour specialized monitoring and care. 

It may take a few hours until the major effects of anesthesia wear off and you are alert. When you wake up, you may have a breathing tube in your mouth and tubes and wires attached to your body. These allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids. 

You will not be able to talk if you have a breathing tube. However, the care team usually removes it within 24 hours. You may have a sore throat from the breathing tube. This is usually temporary, but tell your care team if you are uncomfortable.

You will likely recover faster and move out of the ICU sooner than with traditional open-heart surgery. Hospital stays after hybrid coronary bypass range from three to five days, as compared to up to a week or more for open-heart surgery.

Recovery after surgery is a gradual process. Recovery time varies depending on your general health, your age, and other factors. Your doctor will likely refer you to a cardiac rehabilitation program to help you recover. Your surgeon will tell you when it is safe to return to your normal activities. Full recovery takes several weeks. 

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up and cardiac rehabilitation appointments after hybrid coronary bypass. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

  • Bleeding

  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Change in alertness, such as passing out, unresponsiveness, or confusion

  • Chest pain, chest tightness, chest pressure, or palpitations

  • Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

  • Inability to urinate or have a bowel movement

  • Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

  • Pain that is not controlled by your pain medication

  • Unexpected drainage, pus, redness or swelling of your incisions

How might hybrid coronary bypass affect my everyday life?

Hybrid coronary bypass may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. For example, hybrid coronary bypass should relieve chest pain and reduce your risk of heart attack. 

Hybrid coronary bypass will not prevent heart disease from coming back. You can make changes to your everyday life that may help prevent or delay recurrence of heart disease such as:

  • Eating a heart-healthy diet

  • Getting regular exercise

  • Maintaining a healthy weight

  • Practicing stress management techniques

  • Quitting smoking

  • Treating other related conditions, including high blood pressure, high cholesterol, and diabetes

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 23, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Bonatti J, Schachner T, Bonaros N, Lehr EJ, Zimrin D, et al. Robotically Assisted Totally Endoscopic Coronary Bypass Surgery. Circulation. 2011;124: 236-244. http://circ.ahajournals.org/content/124/2/236.full
  2. Hybrid Approach to Coronary Artery Disease. Mayo Clinic. http://www.mayoclinic.org/medicalprofs/hybrid-approach-coronary-artery-disease.html
  3. Hybrid Intervention. University of Maryland Medical Center. http://umm.edu/programs/heart/services/programs/surgery/cabg/hybrid
  4. Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf
  5. Robotically Assisted Coronary Bypass Surgery. Cleveland Clinic. http://my.clevelandclinic.org/heart/services/surgery/robotically-assisted-coronary-artery-bypass-sur...
  6. Verhaegh AJ, Accord RE, van Garsse L, Maessen JG. Hybrid coronary revascularization as a safe, feasible, and viable alternative to conventional coronary artery bypass grafting: what is the current evidence? Minim Invasive Surg. 2013;2013:142616. doi: 10.1155/2013/142616. Epub 2013 Apr 3. http://www.hindawi.com/journals/mis/2013/142616/

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