Quadruple Bypass Heart Surgery Process and Recovery

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A quadruple bypass surgery is an open heart surgical procedure that is done to improve the blood flow that feeds the heart. Many people are diagnosed with heart disease—and the need for surgery—after experiencing chest pain, shortness of breath, or common symptoms like arm or jaw pain. 

To understand what it means to have a quadruple bypass, it is essential to understand the anatomy of the heart and the effects of heart disease.

Anatomy of the Heart

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.

To be clear, the heart pumps blood to the entire body through muscular contractions that keep blood moving. The heart, like every tissue of the human body, also needs to be fed oxygen and nutrients from the bloodstream. The blood vessels that feed the heart what it needs are called the coronary arteries and their small size can contribute to their becoming clogged easily with plaque.

We care about the coronary arteries so much because, in some people, the coronary arteries become blocked—a condition known as coronary artery disease—where plaque builds up in the blood vessel.

If the blockage in the coronary artery is severe, it can prevent blood flow to the part of the heart that is fed by the diseased blood vessel, causing chest pain, also known as angina. If the blockage is severe enough and the blood flow is dramatically decreased or completely stopped, a heart attack is typically the result. It is possible to have several arteries blocked in this manner, which can pose a significant risk to the heart.

A quadruple bypass is performed when four blood vessels are blocked and need to be bypassed. This means four different blockages require blood to be rerouted around them.

Coronary Artery Disease Treatment

In many cases, coronary artery disease can be treated with medication, lifestyle changes, and less invasive procedures such as angioplasty. When it cannot be treated with less invasive treatments or those treatments don't stop damage from being done to the heart, or chest pain continues, it is often appropriate to consider coronary bypass surgery.

Surgery has greater risks than less invasive procedures, including the risk associated with general anesthesia and the risks of open heart surgery, so this procedure is typically only an option if the disease is severe or does not respond to other types of treatment. The quadruple bypass surgery is a complicated procedure and the risks of surgery increase with each additional bypass graft.

For example, the double bypass surgery is less risky than a triple, and a triple is less risky than a quadruple bypass. With each additional bypass that is needed the surgery is longer, requires more time under anesthesia, and is being done to treat more severe disease.

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During the Procedure

The procedure starts with general anesthesia being administered while the surgeon or another healthcare provider, such as a physician assistant (PA) starts the procedure by harvesting veins from the extremities for the bypass grafts. While the assistant is recovering the vessels—and once they are sure the vessels are of good enough quality to be used during the procedure—the cardio-thoracic surgeon opens the chest and begins preparing the heart for the procedure.

The surgeon will also frequently take an additional vessel from the left chest to supplement the veins obtained from the leg, or in some cases, vessels from the arm. During the surgery, the recovered blood vessels are grafted onto the existing heart vessel before and after the blockage. It is not unlike a quick detour you might take to avoid an accident, with the blood literally being rerouted around the blocked portion of the vessel.

During the vast majority of quadruple bypass surgeries, the heart is stopped so that the surgeon is not working on a moving target. This is done by using a heart-lung bypass machine, a complex medical device that supplies oxygen to the blood instead of the lungs and pumps it through the body as the heart would normally do. This machine allows both the heart and lungs to be still and makes it possible to complete the graft portion of the surgery more quickly.

Recovery

The recovery from open heart surgery is not a quick one. The first day after surgery is typically spent in the ICU or a cardiac care unit, where the patient is allowed to wake slowly from anesthesia. Unlike other types of surgery, the patient is not given a medication to wake quickly and instead sleeps off the anesthesia.

Ideally, the patient will be awake, off of the ventilator, and sitting up in a chair at the bedside without six to 12 hours of surgery. This is to decrease the risks of common issues such as blood clots and pneumonia and to start the recovery process as quickly as possible.

Open heart patients typically spend three or more days in the hospital prior to being discharged. Some patients will require cardiac rehabilitation, a structured and monitored exercise program that is designed to strengthen the heart.

The typical recovery lasts six to 12 weeks, and most patients are able to return to their usual activities after their recovery is complete.

Patients who were limited in their activities by chest pain or fatigue caused by heart disease may find that they can better tolerate activity after surgery than before. The major benefits to the patient will be most evident toward the end of the recovery phase when activity can be done with no pain or less pain. For some patients activities as simple as walking were limited by pain before surgery and can be done without pain after surgery. This does not mean that it is OK to rush into activities after surgery, but it does mean that some individuals are able to be more active after their recovery.

It is also important during this recovery to actively work on lifestyle changes that will keep the new grafts open and performing well. This means a heart-healthy diet, with restrictions on saturated fat and cholesterol. Exercise should also be included within the limitations given by the surgeon for the recovery period. After recovery is complete the diet restrictions should continue, along with an exercise program.

A Word From Verywell

A quadruple bypass heart surgery is a complicated procedure. Your surgeon will likely recommend it if it will greatly improve your health and quality of life--and the risks do not outweigh the potential rewards. However, this surgery is not a solution for coronary artery disease on its own. After the procedure, it will be important to implement healthier lifestyle changes in order to improve your overall health.

If you are having the surgery, lifestyle changes may be on the back burner for you as you readjust to your routine, but diet and exercise will be essential long term.

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