What Is a Quintuple Bypass Surgery?

A quintuple bypass is an open heart surgery done to treat severely blocked arteries that feed the heart. The procedure is a complicated one, and to truly understand a quintuple bypass, it is essential to understand the anatomy of the heart and effects of heart disease.

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 surgery is referred to as a quadruple bypass.

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).

The CABG procedure may be performed as an emergency procedure 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.

The vast majority of CABG procedures, including the quintuple bypass, 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.

This wait also gives the patient time to optimize their health prior to the procedure, by eating an aggressively heart-healthy diet, quitting smoking, and getting their 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.

The procedure is performed under general anesthesia and 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. The procedure 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 quadruple 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. The recovery can be a challenging one, and some individuals require cardiac rehabilitation after the procedure, but most patients find that they feel significantly better once they have recovered fully.