Triple Bypass Surgery: What to Expect on the Day of Surgery

Triple bypass surgery is a form of coronary artery bypass graft (CABG) surgery. CABG is the most common type of heart surgery performed on the adult population. Triple bypass simply refers to the number of vessels being bypassed (three). Through the utilization of an open chest technique, surgeons transport three vessels to the heart and surrounding area to bypass the damaged vessels.

By understanding what happens before, during, and after triple bypass surgery, you can increase your chances of success.

Before the Surgery

The day of triple bypass surgery can be hectic and overwhelming. If the surgery is planned, you will have more time to prepare both mentally and physically for the procedure. If it is an emergency, preoperative tests are very time sensitive and multiple examinations may be happening at once.

On the day of the procedure, you will meet with the entire healthcare team including the cardiothoracic surgeon, cardiologist, anesthesiologist, perfusionist, operating room nurses, and other surgeons as needed. All operative consent forms will be signed at this time to ensure you are fully prepared and do not have any additional questions or concerns.

The registered nurse will take vital signs including:

• Heart rate
• Blood pressure
• Temperature
• Respirations
• Pulse oximetry
• Blood sugar
• Pain level

Prior to going into the operating room for the procedure, patients will have preoperative tests done. This will include:

• Echocardiogram
• Electrocardiogram (EKG or ECG)
• Blood work
• Chest X-ray
• Carotid ultrasound
• Pregnancy test (if indicated)

You will also be given a surgical soap that must be used on the surgical sites to properly cleanse the area and prevent infection. After cleaning, you will be given a hospital gown and the nurse will shave the surgical area if needed. The surgeon will mark the surgical site after you are fully prepped.

Your medications will be reviewed by the nurse and surgical team. Be prepared to discuss all of your medications, vitamins, and supplements at this time including the dosages, the last time they were taken, and how often they are taken. Bringing a list of the information is helpful so nothing is missed.

Patients are instructed to empty their bladder prior to going into the operating room, and asked to remove all jewelry, glasses, contact lenses, and dentures if applicable.

Finally, the nurse will insert an intravenous catheter (IV) that will be used to provide hydration, medications, and anesthetics during the procedure.

During the Surgery

When it’s time for the surgery, you will be taken into the operating room on a stretcher and then placed onto the operating room table. You will then be prepared for general anesthesia, which will last for the duration of the surgery. Before the operation begins, the following will take place:

• You will be given a small dose of medication to help you relax while the surgical team is preparing.
• Vital sign monitors are placed.
• Your skin will be cleaned again with surgical cleaner and draped in sterile drapes, exposing only the surgical area(s).
• Once you are sedated by the anesthesiologist, an endotracheal tube will be placed to help you breathe during the procedure. Anesthesia medications relax your muscles making it difficult to breathe and this procedure will allow the team to help control your breathing while on the ventilator.

Once you are fully prepped for surgery, the surgical team will first harvest the three vessels needed for the bypass. Blood vessels can be taken from your leg (saphenous vein), inside your chest (internal mammary artery), or your arm (radial artery).

After the surgeons harvest the vessels, a midsternal vertical incision is made in the center of the chest in order to access the heart. The patient may be placed on a bypass machine during the procedure depending on the surgeon. The surgery can be performed "on-pump" or "off-pump".

On-pump surgery refers to the use of a heart-lung machine that circulates blood and breathes for the body throughout the surgery. The machine allows doctors to stop the heart.

The second technique used is off-pump surgery, also called “beating heart surgery.” It is done while the heart is still beating, and does not use the heart-lung machine. This is a more difficult surgery to perform because of its technical precision, but is the preferred approach for some surgeons.

According to the National Institute for Health and Care Excellence (NICE), the procedure works as well as a coronary artery bypass using a pump. It is a newer technique that has shown some increased benefits, including:

• Quicker than the conventional procedure
• Reduces the chance of bleeding during the surgery
• Decreased risk of certain serious complications after surgery, such as a stroke
• Shortened hospital stay

After the grafts have been placed, the heart is restarted (if needed) via controlled electrical shocks. The surgical incision is closed using mesh webbing, sutures, and/or staples depending on the surgeon's preference.

After the Surgery

Immediately following triple bypass surgery, you will be transferred to the intensive care unit (ICU) or cardiac intensive care unit (CICU or CCU) for close monitoring. You will typically have an endotracheal breathing tube for several hours after surgery and still be connected to a ventilator.

You will be given medication to keep you sleepy. If you start to wake up, you will not be able to talk with the breathing tube. It may feel uncomfortable but shouldn't be painful. Once fully awake, the breathing tube will be removed.

You will spend a minimum of one day in the intensive care unit and will be hooked up to a variety of machines including a monitor for vital signs, an IV pump to deliver fluids and medications, and a catheter to drain your bladder.

After the initial ICU recovery, you will be moved to a telemetry medical-surgical unit to continue your recovery. At this time, you will meet with a physical therapist, occupational therapist, and nutritionist to continue the recovery process.

Following the procedure, everything will be harder to do including eating, dressing, bathing, and other activities of daily living. This is normal and to be expected after undergoing triple bypass surgery. Working with the healthcare team will help you start to feel more normal.

A Word From Verywell

It's important to follow all instructions from the healthcare team before, after, and during triple bypass surgery. This surgery, while the most common open heart procedure, is very serious and there is the possibility of life-threatening complications.

Discuss any concerns and questions with your surgeon prior to the procedure to fully understand not only the surgical procedure but also the recovery process.