Heart Health Heart Disease Treatment Heart Bypass Surgery: Everything You Need to Know By Jennifer Whitlock, RN, MSN, FN linkedin Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine. Learn about our editorial process Jennifer Whitlock, RN, MSN, FN Medically reviewed by Medically reviewed by Yasmine S. Ali, MD, MSCI on January 22, 2021 facebook twitter linkedin Yasmine Ali, MD, is board-certified in cardiology. She is an assistant clinical professor of Medicine at Vanderbilt University School of Medicine and an award-winning physician writer. Learn about our Medical Review Board Yasmine S. Ali, MD, MSCI on January 22, 2021 Print Table of Contents View All Table of Contents What It Is Purpose How to Prepare What to Expect Recovery Heart bypass surgery, or coronary artery bypass graft (CABG) surgery, is done when the blood vessels that feed the heart are too clogged to function properly. The surgery uses blood vessels from another part of the body to re-route blood flow around the blocked arteries. The number of vessels that need to be bypassed dictate the type of bypass surgery performed: single (one artery), double (two), triple (three), or quadruple (four). Verywell / Laura Porter What Is Heart Bypass Surgery? Heart bypass surgery is usually performed as an open-heart procedure, meaning the surgeon opens the chest in order to see the heart and perform surgery. It can be performed as a minimally invasive procedure, but that is less common as the technique is not appropriate for most patients. The surgeon takes blood vessels from another part of the body, including the arm, chest, or legs, and connects them to blood vessels above and below the blocked artery/arteries. These grafts bypass the diseased artery and restore blood flow to the heart. Heart bypass surgery is an inpatient procedure that requires a hospital stay. If you have had a heart attack or sudden cardiac arrest, it may be performed as emergency surgery. The surgery can also be scheduled in advance after evaluating your symptoms, test results, and medical history. Contraindications Outright contraindications include coronary arteries that aren’t compatible with grafting or heart muscle tissue that isn’t viable to graft. Even if these don't apply to you, bypass surgery will only be considered after weighing the risks and benefits in your case. This is a major procedure. Your prognosis, age, and any comorbidities, among other things, will all factor into your doctor's recommendation. Potential Risks The risks associated with an open-heart procedure increase with the number of bypasses required, as the surgery takes longer and the coronary artery disease being treated is more severe. The risks of heart bypass surgery include: Heart rhythm problems Depression and mood swings Postpericardiotomy syndrome, which includes low fever, tiredness, and chest pain Infection Memory loss or loss of mental clarity Heart attack or stroke Kidney failure Lung failure Purpose of Heart Bypass Surgery Your doctor may recommend bypass surgery if you have obstructive coronary artery disease (CAD), which means that plaque has built up in the arteries to the point that it is blocking the supply of blood to the heart. Before surgery, your doctor will likely order diagnostic tests to determine the extent of your coronary artery disease and the location(s) where arteries are narrowed. These tests may include: Stress tests Echocardiogram Coronary angiography CT angiography Electrocardiogram (ECG or EKG) Coronary calcium scan Depending on your overall health and results of your tests, your doctor may suggest a coronary angioplasty instead of heart bypass surgery. This involves placing a stent to open blocked vessels. However, about a quarter of people who have an angioplasty must have it repeated, or have bypass surgery, within a few years. If a heart bypass is planned, your doctor will likely order additional tests to be done the day before your surgery. These include: Chest X-ray Urinalysis EKG of your heart Blood tests Call 911 if you are experiencing a medical emergency. The warning signs of a heart attack include chest pain or discomfort in the center or left side of the chest, shortness of breath, and pain in the arms, back, shoulders, neck, jaw, or upper part of the stomach. How to Prepare If you’re having a scheduled surgery, your surgeon will meet with you to discuss what to expect and how to prepare. Ask your surgeon about any questions you have, including when to bathe before surgery, when to arrive at the hospital, and what to expect the day of the surgery and during recovery. Location Heart bypass surgery occurs in a hospital setting in an operating room. Afterwards, the surgery team will take you to a room in the intensive care unit (ICU) to recover. What to Wear Wear loose comfortable clothes that you can change out of easily. Leave valuables, including jewelry, at home so you don’t have to worry about losing them. You’ll be given a hospital gown before the surgery and may be offered a blanket to help you stay warm. Food and Drink You should stop eating and drinking by midnight the day before the surgery. Check with your doctor or surgeon to make sure there are no other restrictions. Medications Ask your doctor whether you should continue to take your medications before the surgery. About a week before the surgery, they may want you to stop taking medications that would increase the risk of bleeding, including aspirin, ibuprofen, and naproxen. If you take Plavix (clopidogrel), ask your doctor when you should stop taking it. To avoid complications, make sure your doctor knows about all medications, vitamins, and supplements you’re taking before the surgery. What to Bring Remember to bring any paperwork from your doctor as well as insurance cards. Pack a small bag with a change of clothes for when you leave the hospital. Make arrangements for someone to bring you home from the hospital and for someone to stay with you at home for at least one or two weeks while you recover, if possible. Pre-Op Lifestyle Changes You should stop smoking before the surgery. It may make you more likely to have mucus in your lungs, which is hard to remove after surgery. Ask your doctor about suggestions for how to quit. What to Expect on the Day of Surgery The day of your surgery, you may meet with members of your heart care team, including your surgeon and anesthesiologist, to go over the details of your bypass surgery. Before the Surgery You’ll be asked to remove any jewelry, dentures, hair clips, and nail polish. Your chest, groin and legs will be shaved. Your nurse will start an IV to give you fluids. You might also receive medications to help you relax and a facemask to help you breathe oxygen. You’ll be given general anesthesia so you won’t feel any pain and will be asleep for the surgery. During the Surgery The procedure starts with dividing the breastbone to spread the ribs. A heart-lung machine will do the work of the heart and lungs before the surgery. A cardiac perfusionist monitors the heart-lung machine during your procedure. In some cases, heart bypass surgery is performed without a heart-lung machine while the heart is still pumping. This may be safer for those who have a higher risk of complications from using a heart-lung machine, including patients who are elderly and those with ventricular dysfunction, diabetes, chronic lung disease, and kidney disease. The surgeon will remove blood vessels from another area of the body, typically the leg and the left side of the chest. These vessels are then sewn onto the existing heart vessel before and after the blockage so that blood flows around, not through, the problematic artery. This is similar to a detour when there's a road closure. Once the surgeon has finished the procedure, they’ll restart your heart and sew your breastbone back together. Chest tubes are placed to drain fluid that might otherwise build up around your heart and prevent it from functioning well. These tubes are typically removed within a few days of surgery. The anesthesiologist will monitor your vital signs throughout the surgery. The surgery can take four to six hours, depending on the technique being used and whether you are having a single, double, triple, or quadruple bypass. After the Surgery You’ll be taken to the ICU to recover, where you will likely remain for the first couple of days. You will come out of surgery with a breathing tube in place. As you wake up and start breathing on your own, the tube will be removed. For most patients, the goal for the first 12 hours after surgery is not only to wake up and have the breathing tube removed, but to take a few steps and sit up in a chair at least once (preferably twice). This is aimed at not only starting the recovery process but preventing serious complications like blood clots and pneumonia. While you’re in the ICU, your care team will likely do the following: Apply bandages on your chest and areas where the vessels were removed Attach a catheter to your bladder to drain urine Connect an ECG to monitor your heart’s rhythm Implant a temporary pacemaker, which will be removed prior to discharge Monitor your vital signs, including blood pressure and oxygen Provide oxygen therapy through a mask or nasal prongs When your time in the ICU is done, you will move to a regular or transitional care room to finish out your hospital stay, which may be about a week total. Recovery Recovery from this procedure begins in the hospital and continues at home. You will likely feel better around four to six weeks post-surgery, but full recovery can take several months. Your surgeon will want to see you for a follow-up about four weeks after you're discharged, so make sure you set up the appointment. The 4 Phases of Cardiac Rehab Activity Your doctor will probably encourage you to begin cardiac rehabilitation—physical exercise performed under the watchful eye of a therapist—within a few days to help strengthen the heart. As your recovery progresses, you’ll gradually be able to resume other activities. Walking is good exercise—just remember to keep a slow pace. Stop if you feel dizzy, out of breath, or have any pain in your chest. You may be able to return to work about six to eight weeks after surgery. Do not drive for at least four to six weeks afterwards. Check with your surgeon and cardiac rehab therapist about any other restrictions you should follow. Healing At home, you should shower every day and wash the incision gently. Do not take a bath, swim, or soak in a hot tub until your wound is completely healed. In the first weeks after the surgery, you may experience symptoms including: Pain around your incision Shortness of breath Itchy, numb, or tingly skin around the incisions (may last for months) Poor appetite Difficulty sleeping Constipation Feeling tired When to Call Your Doctor Talk to your doctor or surgeon immediately if you have: Pain, redness, heat, or drainage from your incision Temperature of 101 degrees F or higher Weight gain of more than 2 pounds a day for two days in a row Irregular pulse (either very fast or very slow) Shortness of breath Dizziness or fainting Severe headache Cough that doesn’t go away Coughing up blood or yellow or green mucus Coping with Recovery Recovery from heart bypass surgery takes time. The full benefits of the surgery may not be realized until up to six months after it is performed. While it’s good to stay active, and you may want to jump back into your regular life, remember to take things slow. To avoid complications and setbacks, talk to your doctor about your path to recovery and what you can safely handle. If you’re feeling depressed or experiencing mood swings, let your doctor know. They can suggest a counselor who can help you. Also, reach out to family and friends. Let them know specific ways they can help, whether that’s pitching in with chores or finding activities you can enjoy together. Lifestyle Adjustments Part of both your recovery and care long after your surgery is performed is implementing healthier lifestyle changes. Without this, the chances that you will need a second surgery will increase. Follow your doctor’s instructions for how to prevent any future coronary artery blockages. This should include: Eating a heart-healthy diet Exercising regularly Treating high blood pressure, high blood sugar, or high cholesterol Not smoking Continue to take any medications that your doctor prescribes, whether it’s for your heart or another condition. A Word From Verywell If you or a loved one is having heart bypass surgery, knowing what to expect will help you prepare for the surgery and the recovery afterward. Keep an open line of communication with your doctor and surgeon. Don't hesitate to bring up any thoughts or questions that come to mind. If you can, bring along a loved one to help you take notes and understand the procedure. Was this page helpful? Thanks for your feedback! Did you know the most common forms of heart disease are largely preventable? Our guide will show you what puts you at risk, and how to take control of your heart health. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Doenst T, Diab M, Sponholz C, Bauer M, Färber G. The opportunities and limitations of minimally invasive cardiac surgery. Deutsches Aerzteblatt Online. 2017. doi:10.3238/arztebl.2017.0777 National Heart, Lung, and Blood Institute. Coronary artery bypass grafting. Bachar JB, Biagio M. Coronary artery bypass graft. StatPearls. Updated May 17, 2019. Medlineplus. Heart bypass surgery. Updated February 28, 2018. Harvard Health Publishing. Angioplasty or bypass surgery? Updated April 2008. Johns Hopkins Medicine. Coronary artery bypass surgery. National Heart, Lung, and Blood Institute. Heart attack. MedlinePlus. Heart bypass surgery – discharge. Updated July 25, 2018.