Coronary Artery Bypass Surgery

Preparing the Bypass Graft

First, a healthy blood vessel (graft) is taken from another part of the body. Taking this graft usually doesn't affect blood flow in that body part. If you have more than one blockage, which is often the case,more than one graft may be needed. One or more of these blood vessels will be used for the graft:

• The saphenous vein, which is located in the leg.

• The radial artery, which is located by the wrist.

• The internal thoracic (mammary) arteries, which are located in the chest wall. There are two internal thoracic arteries, one on each side of the chest. Typically, the left on is used, but sometimes both are used.

Reaching the Heart

While one member of the bypass team is harvesting the graft(s), another member works to expose your heart. First, an incision is made in the chest. Then the breastbone (sternum) is opened down the middle and then pulled apart. The breastbone is held open throughout surgery. This puts pressure on the nerves of the chest. This is why you may have soreness and muscle spasms in your chest, shoulders, and back during recovery.

Attaching the Graft

A small opening is made in the coronary artery, past the blockage.

• If a saphenous vein or radial artery is used, one end of the graft is sewn onto this opening. The other end is typically sewn on to the aorta. The diseased artery is not removed. If a stent is present, it is not removed either, as will have grown into the artery already.

• If the internal thoracic (mammary) artery is used, one end of the graft is sewn onto this opening. The other end is already attached to a branch of the aorta.

Finishing Up

Once the graft has been attached, blood will start flowing through this new pathway to bypass the blockage. If you have multiple blockages, more than one bypass may be done. Then your breastbone is rejoined with wires. These wires will stay in your chest permanently. Rarely do they cause a problem, and they are safe around microwaves and airport metal detectors. The incision is closed, and you are taken to the intensive care unit to begin your recovery.

Using a Heart-Lung Machine

Coronary artery bypass surgery can be done with the heart still beating (off pump) or with the heart still (on pump.) Your surgery team can tell you more about which type of procedure you will have.

• On-pump procedure. A machine does the work of your heart and lungs during surgery. Blood is circulated through a heart-lung machine. The machine supplies the blood with oxygen and pumps it back through the body. In these cases, the heart may be stopped temporarily before the graft is attached. Your own heart and lungs start working again after the bypass is completed.

• Off-pump procedure. The heart-lung machine is not used and the heart is not stopped. This is sometimes called a "beating heart" procedure.

There are advantages and disadvantages to each technique. If you have a question about why your doctor is using one technique, instead of the other, do not be afraid to ask.