Quintuple Bypass Surgery: Everything You Need to Know

Quintuple bypass surgery is a complex open heart surgery. It's done to treat five severely blocked major arteries that feed the heart.

Under general anesthesia, blood vessels are removed from another part of the body and transplanted onto the existing heart vessel. This reroutes blood flow around the blockage and improves blood supply to the heart.

Quintuple bypass surgery is also called quintuple coronary artery bypass graft surgery.

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 supply 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. For example, if two vessels are blocked, the surgery is called a double bypass. If four vessels are blocked, the procedure is referred to as a quadruple bypass surgery.

When you have quintuple bypass surgery, this means you have five blocked arteries. During the surgery, these blockages are bypassed with healthy blood vessels taken from somewhere else in your body. 

Quintuple bypass surgery is usually an open procedure. This means the surgeon makes an incision in the center of the chest and opens the ribcage. 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

Quintuple Bypass Surgery Risks

All surgeries have some risk. A quintuple bypass surgery is the most complicated bypass surgery, in part because it can be challenging to find adequate bypass vessels.

Some of the potential quintuple bypass surgery risks include:

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

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 blockage(s) are so severe that surgery is necessary to make sure the heart continues to receive adequate blood flow. This surgical procedure is known as coronary artery bypass graft surgery (CABG).

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 if the patient is healthy enough to tolerate the surgery and their general state of health.

The CABG procedure may also be performed as an emergency procedure. This may happen when the patient comes to the emergency room with significant chest pain and is diagnosed with severe coronary artery blockages. Typically, a cardiac catheterization is performed, then the CABG surgery follows if the surgeon feels that it will be effective and is necessary for treatment.

Location

Most coronary bypass surgeries take place at a hospital. Coronary bypass is an inpatient procedure, so expect to spend at least 4 to 5 days in the hospital after the surgery.

What To Wear

Choose comfortable clothes to wear to the hospital. You'll need to change into this clothing when you leave the hospital, so make sure it is loose-fitting and made of soft material. This will help reduce irritation.

You may also want to pack something comfortable to change into once you are in a hospital room.

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 take, even topical medication, 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 blood pressure medication.

What To Bring

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

• 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, by eating an aggressively heart-healthy diet, quitting smoking, and getting your blood sugar under control. These kinds of measures can improve the final outcome after surgery and are a great opportunity to decrease the risks associated with surgery.

You will need to quit smoking 2 to 4 weeks before surgery and abstain from alcohol for at least 2 days prior to your procedure. It is also important to remain active in the weeks before your surgery.

What To Expect on the Day of Surgery

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.

Before the 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 the Surgery

The procedure starts with blood vessels being taken from another area of the body, often the leg, and grafted onto the existing heart vessel before and after the blockage.

A quintuple bypass requires more vessels than any other procedure, so multiple sites, including the arm, left internal mammary artery (LIMA), and other vessels may be used.

Obtaining adequate vessels to use for the grafts can be one of the most challenging aspects of the procedure; if the vessels to the heart are diseased, it is likely that the vessels in other regions of the body are also affected.

These vessels are then used to detour blood around the blockage on the way to the heart, with the blood literally being routed around (bypassed) the blocked portion of the vessel.

Once the vessels needed for the grafts are harvested, 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.

Quintuple bypass is most often performed "on pump" using a cardiopulmonary bypass machine to temporarily do the work of the heart and lungs, allowing the surgeon to stop the heart and perform surgery without the constant movement of the heart beating. In some cases the procedure is done "off pump," but this is far less common.

The time it takes to complete quintuple bypass surgery varies, but between 3 and 4 hours is typical.

After the Surgery

When the surgery is complete, you'll be moved to the intensive care unit (ICU) or coronary intensive care unit (CICU) where you'll 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 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

At home, you will need to keep your incision clean and dry.

Make sure to notify your healthcare provider if:

• You have a fever of 100.4 or higher
• You have nausea that won't go away or frequent vomiting
• You have an increase in pain at the incision, redness, swelling, bleeding, or other drainage
• You have difficulty breathing
• Your pulse is rapid or irregular
• You have swelling or numbness in your arms and legs

You may not be able to drive for a period of time following the surgery. Your healthcare provider will let you know when it's okay to resume this activity.

Coping With Recovery

Quintuple bypass recovery can be difficult. In the few weeks after surgery, you may feel fatigued and you may experience pain at the surgical sites. You won't be able to resume normal activities for four to six weeks.

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.

It is important to stick to your daily routine as much as possible during your recovery. Make sure to get plenty of rest and 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%. It is possible to live for many years after quintuple bypass surgery. Studies into long-term outcomes up to 40 years after coronary bypass surgery have found an estimated life expectancy of 18 years. 

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 after bypass surgery to return to normal within a few weeks or months. Long term, you will need to change your diet and lifestyle in order to avoid additional surgeries. 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.

If you have diabetes or high blood pressure, it is important to make sure these conditions are well-managed. Quitting smoking, limiting alcohol, and losing weight are other key components of a healthy lifestyle.

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 bypasses five blocked coronary arteries. It is usually an open procedure requiring a hospital stay of 4 or 5 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.

A Word From Verywell

The quintuple bypass surgery is a serious one, but it often transforms the life of the patient by eliminating chest pain and allowing participation in exercise and other activities.

Quintuple bypass recovery can be challenging, and some individuals require cardiac rehabilitation after the procedure, but most patients find that they feel significantly better once they have recovered fully.