Quintuple Bypass Surgery: Everything You Need to Know

Quintuple bypass surgery is a complex procedure done to treat people with five severely blocked major arteries that feed the heart. Blood vessels are removed from another part of the body and transplanted onto each affected heart vessel to reroute blood flow around the blockages.

This surgery—also called quintuple coronary artery bypass graft surgery—improves blood supply to the heart, reducing pain, shortness of breath, and possibly the risk of cardiac-related death.

This article discusses quintuple bypass surgery, why it's done, and what happens during the procedure. It also talks about recovery time and long-term outlook.

What Is Quintuple Bypass Surgery?

Quintuple bypass surgery is a surgical procedure done to treat blocked coronary arteries. The coronary arteries are the blood vessels that give the heart with its own blood supply. These are different than the vessels that supply the blood pumped by the heart.

In some people, the coronary arteries become blocked, a condition known as coronary artery disease. It is possible to have one or more arteries blocked in this manner, which can pose a significant risk to the heart.

When you need a quintuple bypass, it means you have five blocked arteries.

A surgeon takes healthy blood vessels from somewhere else in your body and transplants them onto the coronary arteries with the blockages, essentially creating detours for blood flow. In doing this, the blockages remain, but blood is no longer impeded by them because it can travel these new pathways.

Quintuple bypass surgery is usually an open procedure done under general anesthesia. A surgeon makes an incision in the center of the chest and opens the ribcage to access the arteries.

Some surgeons perform minimally invasive bypass surgery. This is done through a small incision in the chest and involves the use of video and special surgical instruments.

Contraindications

Quintuple bypass surgery is not right for everyone. Your healthcare provider may not recommend this surgery if:

• You are obese
• You've recently had a heart attack
• You have a pre-existing condition such as diabetes, kidney failure, chronic obstructive pulmonary disease, or cancer

Potential Risks of Quintuple Bypass

All surgeries pose some risks. Potential risks of quintuple bypass surgery include:

• Abnormal heart rhythm
• Pneumonia
• Blood clots that lead to heart attack or stroke
• Breathing difficulty
• Kidney failure
• Graft failure
• Death

A quintuple bypass surgery is the most complicated bypass surgery, in part because it can be challenging to find enough adequate bypass vessels to harvest. (If the vessels to the heart are diseased, it is likely that the vessels in other regions of the body are affected, too.)

The surgery is also more involved and longer than a bypass procedure involving fewer arteries, like a double bypass.

Purpose of Quintuple Bypass Surgery

If a blockage is serious enough, it can prevent or minimize blood flow to the part of the heart that is fed by the diseased blood vessel, causing chest pain and muscle damage.

When the coronary arteries are completely blocked, the muscle that makes up the heart is starved of oxygen. This oxygen deprivation causes significant pain, and the resulting heart damage is referred to as a heart attack or myocardial infarction (MI).

In some cases, coronary artery disease can be treated with medication, lifestyle changes such as diet and exercise, and less invasive procedures, including the placement of stents.

However, for some patients, the blockages are so severe that coronary artery bypass graft surgery (CABG) is needed to make sure the heart continues to receive the blood flow it needs.

How to Prepare

The vast majority of CABG procedures, including quintuple bypass surgery, are scheduled in advance. This allows time for pre-surgery testing that helps determine:

• How many bypasses are needed
• Your general state of health
• If you can tolerate the surgery

Typically, a cardiac catheterization is performed first. CABG surgery follows if the surgeon feels that it will be effective and is necessary for treatment.

A bypass may also be performed as an emergency procedure. This may happen when someone comes to the emergency room with significant chest pain and is only then diagnosed with severe coronary artery blockages.

Location

Most coronary bypass surgeries take place at a hospital. Coronary bypass is an inpatient procedure, so expect to spend at least four to give days there after the surgery.

What to Wear

If you plan to wear the outfit you arrived in when you get released, choose something loose-fitting and soft. A top that zips or buttons up is ideal.

Otherwise, pack such an outfit for your return home. You might want extras to wear while in the hospital as well.

Food and Drink

Typically, you will need to avoid eating or drinking anything after midnight on the night before your surgery. This usually includes water. These restrictions will help prevent nausea and vomiting.

Medications

Ask your surgeon if you should discontinue any medications prior to surgery. Make sure your surgeon knows all the medications you use, even topical medications, eye drops, dietary supplements, vitamins, and over-the-counter drugs.

In particular, avoid taking medication that affects blood clotting. This includes:

• Bayer (aspirin)
• Advil (ibuprofen)
• Vitamin E
• Fish oil
• Coumadin (warfarin)
• Plavix (clopidogrel)
  
• Other medications that thin the blood
  

Your surgeon may also tell you to stop taking medication to treat diabetes and/or high blood pressure.

What to Bring

There are a few items that are important to have with you when you have major surgery:

• Your insurance card and ID card
• Emergency contact information
• Legal paperwork such as a living will or healthcare proxy
• A list of current medications, both prescription and non-prescription
• Eyeglasses, contacts, dentures, and their storage containers

You may want to pack ahead of time and have someone bring your bag to you once you've been moved to a standard hospital room. Don't bring valuables, credit cards, or large amounts of cash with you to the hospital.

Pre-Op Lifestyle Changes

The weeks before surgery give you time to optimize your health prior to the procedure. This includes:

• Eating an aggressively heart-healthy diet
• Being physically active
• Quitting smoking (at least two to four weeks before surgery)
• Getting your blood sugar under control
  

You will also need to abstain from alcohol for at least two days prior to your procedure.

These kinds of measures can improve the final outcome after surgery and are a great opportunity to decrease the risks associated with surgery in general.

What to Expect the Day of Your Quintuple Bypass

You may be asked to shower the night before and the morning of the surgery with a special cleanser.

When you arrive at the hospital, your surgeon will explain the procedure and let you know what to expect when you wake up. You'll also need to sign a consent form.

The below reviews what happens before, during, and after an open quintuple bypass, which is the more common surgical approach.

The entire procedure typically takes between three and four hours, though this varies.

Before Surgery

Before you are prepared for the procedure, your surgeon may order blood tests so they know how long it takes for your blood to clot.

If you are wearing jewelry, you'll need to remove it before changing into a hospital gown. You will also be asked to empty your bladder.

In the operating room, you will lie on your back on a table. An anesthesiologist will attach monitoring equipment that will keep track of your breathing, heart rate, blood pressure, and blood oxygen.

You will then be placed under general anesthesia and fitted with a breathing tube.

During Surgery

Quintuple bypass is most often performed "on pump" using a cardiopulmonary bypass machine to temporarily do the work of the heart and lungs. This allows the surgeon to stop the heart and perform surgery without the constant movement of the heart beating.

The procedure can be done "off pump," meaning a bypass machine is not used, but this is far less common.

The procedure starts with blood vessels being harvested from other areas of the body. A quintuple bypass requires more vessels than any other procedure, so donations from multiple sites—including the leg, arm, chest (the left internal mammary artery), and others—may be used.

Once the vessels needed for the grafts are secured, the chest portion of the surgery begins with a sternotomy, the incision that opens the chest and divides the sternum (breastbone) in half to allow the surgeon access to the heart.

Then, each harvested vessel is grafted onto an affected heart vessel before and after the blockage. This re-routes blood that is on the way to the heart, bypassing the blocked portion of the vessel.

After Surgery

When the surgery is complete, you'll be moved to the intensive care unit (ICU) or coronary intensive care unit (CICU). There, you will be observed until your condition is considered stable.

Your breathing tube will be left in place until you are in stable condition and able to breathe on your own. You will be asked to take a series of deep breaths every few hours to prevent pneumonia, a possible complication of any major surgery.

You'll receive medication to help manage your pain.

Once you are taken to a standard hospital room, you will be encouraged to get out of bed and walk for increasingly long periods of time. You'll be released from the hospital when your surgeon says you're ready.

Quintuple Bypass Recovery

While you recover at home, it is important to follow your surgeon's instructions to help prevent post-surgical complications.

Healing

Quintuple bypass recovery can be difficult. In the few weeks after surgery, you may feel fatigued and experience pain at the surgical sites. Rest and use recommended pain relievers as needed.

You won't be able to resume normal activities, including driving, for four to six weeks. Your healthcare provider will let you know when it's OK to get back to your normal routine.

At home, you will need to keep your incision clean and dry. Follow your surgeon's instructions for wound care.

Cardiac Rehabilitation

Cardiac rehabilitation is an important part of the bypass surgery recovery process. It is a supervised program that combines physical therapy with mental health services and healthy living education. The goal of the program is to help strengthen your heart and improve your physical and mental health. Most people complete the program in around 12 to 18 weeks.

During cardiac rehabilitation, you'll work with your healthcare provider, physical therapists, counselors, and nutritionists. In addition to rehabilitation exercises, you'll also learn healthy living skills, how to take your medication, and how to improve your diet and nutrition. If you need help quitting smoking, cardiac rehabilitation can help with that as well. 

People who complete cardiac rehabilitation reduce their risk of death in the 5 years after bypass surgery by around 35%.

Coping With Recovery

Besides physical pain and difficulty performing day-to-day tasks, you may have emotional problems such as depression, anxiety, mood swings, and feelings of helplessness.

While you need lots of rest, avoid isolating yourself from friends and family.

Resume hobbies and other activities as soon as you are able, and be sure to walk each day as advised by your healthcare provider.

If you're having a hard time coping, look for a support group of other people who have also had bypass surgery.

Long-Term Care

Coronary bypass is one of the most common surgeries. The overall success rate is around 98%.

After recovery, the outlook for heart bypass patients is good. Most people who have fully recovered from bypass surgery report improved physical and mental quality of life.

Possible Future Surgeries

Some people need additional future surgeries after recovering from bypass surgery. Because the surgery does not correct coronary artery disease—the condition that made the surgery necessary—it is possible that your arteries may become blocked again.

Lifestyle Adjustments

It is possible for life to return to normal within a few weeks or months after bypass surgery. Long term, you will need to change your lifestyle in order to avoid additional surgeries.

This includes:

• Eating a healthy diet: Adopting a diet high in fruits and vegetables, whole grains, and healthy fats can help reduce your risk of additional blockages. You should also avoid eating foods high in sodium.
• Managing chronic conditions, especially diabetes and high blood pressure
• Quitting smoking, if applicable
• Limiting alcohol (or eliminating it entirely)
• Reaching a healthy weight—and maintaining it

Talk to your healthcare provider about the type of exercise you should do after quintuple bypass surgery. Once you have recovered, you should aim for 30 minutes of moderate-intensity exercise each day.

Summary

Quintuple coronary bypass surgery is a procedure that uses harvested vessels from elsewhere in your body to re-route blood flow around five blockages in arteries that supply the heart. It is usually an open procedure requiring a hospital stay of four or five days. 

Quintuple bypass surgery carries some risks, including blood clots that may lead to heart attack or stroke. 

Recovering from quintuple bypass surgery can be a long and difficult process, but most people make a complete recovery and are able to return to normal day-to-day activities. Making lifestyle and diet adjustments after you've recovered can help prevent future additional surgeries.