Bypass Surgery

Bypass surgery builds new routes for blood to reach heart muscle beyond the narrowed sections of the coronary arteries. Your surgeon takes healthy vessels from elsewhere in your body and attaches them so that blood arrives past the obstruction.

The graft that matters most is the internal mammary artery, which runs down the inside of the chest wall. It is left attached to its origin, its far end joined to the artery on the front of the heart, and it stays open for decades in the great majority of people. Additional grafts come from the long saphenous vein in the leg, taken through small cuts or a single long one, and sometimes from the radial artery in the forearm. Three or four grafts in one operation is usual.

The heart is reached through the breastbone, which is divided down the middle and wired back together at the end. Most operations use the heart-lung bypass machine, which takes over the circulation so the heart can be stopped and still while the fine joins are made; some surgeons perform the joins on a beating heart instead. Both are established techniques and your surgeon will explain which they intend and why.

You are admitted a day or two beforehand for blood tests, cross-matching, dental review and a wash with an antiseptic solution. Certain blood-thinning medicines are stopped several days in advance on a schedule your team will give you.

The operation is under a general anaesthetic and you are fully asleep. It takes three to six hours depending on how many grafts are needed.

You wake in intensive care, usually still on a breathing machine for the first few hours, with chest drains, a urinary catheter, monitoring lines and temporary pacing wires. The breathing tube comes out once you are awake and breathing well. This first day is the part people fear most and remember least. Drains come out in a day or two, you sit out of bed on the first day and walk on the second, and you move to the ward after one to two days. Most people are in hospital five to ten days in total.

The breastbone takes six to eight weeks to knit and it sets the rules. No lifting, pushing or pulling anything heavier than about two to three kilograms for those weeks, no carrying children or shopping, and get in and out of bed rolling onto your side instead of sitting straight up. Hold a pillow against your chest when you cough, and cough anyway, because the breathing exercises prevent the chest infections that are the commonest setback.

The leg wound where a vein was taken is often more troublesome than the chest. Keep the leg elevated when sitting; ankle swelling is common for several weeks.

Do not drive for four to six weeks, both because of the breastbone and because an emergency stop against a seatbelt is exactly the force it cannot take. Expect poor sleep, low mood and a short temper in the first few weeks; this is very common after heart surgery and it lifts. Desk work restarts at six to twelve weeks and physical work later. Join a cardiac rehabilitation programme as soon as you are referred, since supervised exercise and education after bypass surgery measurably improve how you do. Resume sexual activity when you can manage two flights of stairs comfortably.