Quadruple Bypass Heart Surgery Process and Recovery

Quadruple bypass surgery is an open-heart surgical procedure that is done to improve blood flow to the heart muscle. In an open-heart surgery, the chest is cut open and the person is put on a machine to do the work of the heart and lungs during the surgery.

To understand what it means to have a quadruple bypass, it is important to have an idea of the effects of heart disease and how the disease relates to the structure of the heart. This will help you to understand when bypass surgery may be needed and what it achieves.

This article explains the goals of this procedure and walks you through the steps leading up to it. It also describes what to expect during recovery and some common lifestyle changes after it's over.

What is quadruple bypass heart surgery?
Verywell / Tim Liedtke

Anatomy of the Heart

The heart's muscle pumps to keep blood moving throughout the body.

The heart, like every tissue of the human body, needs oxygen and nutrients so it can do its work. The coronary arteries are blood vessels that supply the heart muscle with blood. Sometimes these blood vessels can become blocked.

A quadruple bypass heart surgery is performed when four blood vessels that feed the heart are blocked. The surgery is needed to reroute blood around the blockages with vessels taken from other parts of the body. Each of these replaced vessels is called a bypass graft.

Purpose of Quadruple Bypass

The coronary arteries can become blocked when plaque builds up inside the blood vessels. This condition is known as coronary artery disease.

If the blockage in the coronary artery is severe, it can interfere with blood flow to a section of the heart muscle and cause chest pain, also known as angina. It is possible to have several arteries blocked at the same time, which can pose a significant risk to the heart.

Usually, the chest pain occurs during physical exertion. This is because the demand for oxygen in the heart is greater. The narrowed vessels are not able to meet the increase in the heart muscle's needs. That is when the chest pain will begin.

If the blockage severely or completely prevents blood from flowing to a part of the heart muscle, a heart attack may occur.

In many cases, coronary artery disease can be treated with medication or lifestyle changes. It also may be treated with surgery that is less invasive than a quadruple bypass, such as angioplasty. A stent, a tube that holds the artery open to restore blood flow, may be placed in the artery.

In general, if one or two vessels need to be repaired, or if the blockage is too long to place a stent, then surgery is likely to be recommended. At the time of bypass surgery, all of the blocked vessels will usually be treated at the same time.

Recap

The heart depends on blood flow that delivers the oxygen and nutrients it needs to keep working properly. If plaque builds up in the vessels feeding the heart and causes coronary artery disease, then it may block the blood flow. If the blockage is severe enough, and other options are not a solution, then bypass surgery may be needed to restore blood flow to the heart muscle.

Potential Risks

Surgery can have more risks than less invasive procedures. They include the risks associated with general anesthesia, in which the patient is put to sleep, and the risks of open-heart surgery. For this reason, bypass surgery is usually only considered when coronary artery disease is severe or has not improved with other types of treatment.

Bypass surgery is a complicated procedure. The risks increase with each additional bypass graft that's needed. For example, double bypass surgery is less risky than a triple, and a triple is less risky than a quadruple bypass.

The procedure takes longer and requires more time under anesthesia for each additional bypass. It's also important to consider that it's being done to treat a severe disease state, and a person's underlying health also increases the risk of surgery.

Coronary Artery Disease Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Old Man

What to Expect on the Day of Surgery

General anesthesia is started right before the surgical procedure. Then the cardiothoracic surgeon starts harvesting (removing) veins from the legs or arms. These vessels are used for bypass grafts.

The surgical team will confirm that the vessels are healthy enough to be used to bypass the diseased coronary arteries. Meanwhile, the surgeon opens the chest and begins preparing the heart. They may also remove another vessel from the left chest, to supplement the other veins already harvested.

During the vast majority of quadruple bypass surgeries, the heart is stopped to prevent motion. A heart-lung bypass machine is used to allow both the heart and lungs to be still.

This helps the surgical team complete the graft portion of the surgery safely and quickly. The machine supplies oxygen to the blood instead of the lungs doing so. It pumps the oxygenated blood through the body as the heart would normally do.

During surgery, the blood vessels are attached to the existing heart vessel, around the areas of blockage. It's similar to a quick detour you might take to avoid traffic, with the blood literally rerouted around the blocked portion of the cardiac artery.

Recap

Quadruple bypass surgery means that four of the arteries feeding your heart are blocked. All four of them will need vessels grafted onto them in order to restore blood flow to the heart.

During the procedure, your own heart is stopped so that surgeons can do their work. A machine continues to deliver oxygen to the blood and pump it through the body until the surgery is over and recovery begins.

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. There, you will wake up slowly from anesthesia. Unlike other types of surgery, you won't be given any medication to wake back up quickly. Instead, you would sleep off the anesthesia.

Ideally, you will be awake, off of the ventilator (breathing machine), and sitting up in a chair at the bedside within six to 12 hours of surgery. Avoiding a delay reduces the risk of complications after surgery, such as blood clots and pneumonia. This serves 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 people will require cardiac rehabilitation, a structured and monitored exercise program that is designed to strengthen the heart.

The typical recovery lasts between six to 12 weeks. Most people are able to return to their usual activities after recovery is complete.

After surgery, some patients whose activities were limited due to chest pain or fatigue caused by heart disease may find they can do more. For example, many people who reported chest pain with simple activities, such as walking, will no longer have these symptoms.

This does not mean that it is OK to rush into physical activity after surgery. It does mean that some people are able to be more active after recovery. The major benefits will become more clear toward the end of the recovery phase, when the pain from the surgery itself goes away.

After surgery, it's important to work on lifestyle changes that will keep the new grafts open and working well. These changes may include a heart-healthy diet, with limits on saturated fat and cholesterol.

Exercise also will help. A gradual increase in activity, as directed by your healthcare providers, will help to prevent coronary artery disease from returning.

Summary

A quadruple bypass heart surgery may be necessary if coronary artery disease has caused plaque to build up in the blood vessels and blocked blood flow to the heart. These blockages need to be "bypassed" so the blood flow is rerouted past them.

Your surgeon will take other blood vessels from your body, usually in the legs or arms, and use them to do the bypass. This means they are grafted onto the existing arteries that feed the heart muscle. Once the surgery is complete, blood flow should be restored as it moves around the blockages.

The surgery has its risks, so it is done only when the benefits outweigh those risks. People who have the procedure usually stay in the hospital for a few days. Recovery may take up to 12 weeks.

A Word From Verywell

A quadruple bypass heart surgery is a complicated procedure. Your surgeon may recommend it if they think it will improve your health and quality of life, and if the risks do not outweigh the rewards.

However, this operation is not a "cure" for coronary artery disease on its own. After the surgery, it will be important to make lifestyle changes in order to improve your overall health. Remember that recovery takes time as you readjust to your routine and begin to become more active again.

Was this page helpful?
20 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.
  1. Harris R, Croce B, Tian DH. Coronary artery bypass graftingAnn Cardiothorac Surg. 2013;2(4):579. doi:10.3978/j.issn.2225-319X.2013.07.05

  2. Goodwill AG, Dick GM, Kiel AM, Tune JD. Regulation of coronary blood flowCompr Physiol. 2017;7(2):321–382. doi:10.1002/cphy.c160016

  3. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Coronary artery disease: Overview.

  4. Escobar E. Hypertension and coronary heart disease. J Hum Hypertens. 2002;16 Suppl 1:S61-3. doi:10.1038/sj.jhh.1001345

  5. Agewall S. [New guidelines for angina pectoris]. Tidsskr Nor Laegeforen. 2014;134(5):510. doi:10.4045/tidsskr.13.1552

  6. Webster KA. Mitochondrial death channelsAm Sci. 2009;97(5):384–391. doi:10.1511/2009.80.384

  7. Russ M, Werdan K, Cremer J, Krian A, Meinertz T, Zerkowski HR. Different treatment options in chronic coronary artery disease: when is it the time for medical treatment, percutaneous coronary intervention or aortocoronary bypass surgery? Dtsch Arztebl Int. 2009;106(15):253–261. doi:10.3238/arztebl.2009.0253

  8. Manda YR, Baradhi KM. Cardiac catheterization, risks and complications. [Updated 2018 Nov 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;

  9. Froehlich JB, Eagle KA. Anaesthesia and the cardiac patient: the patient versus the procedureHeart. 2002;87(1):91–96. doi:10.1136/heart.87.1.91

  10. Lai T, Babb Y, Ning Q, et al. The transition from open to endoscopic saphenous vein harvesting and its clinical impact: The Texas Heart Institute experienceTex Heart Inst J. 2006;33(3):316–320. PMID: 17041688

  11. Al-Sabti HA, Al Kindi A, Al-Rasadi K, Banerjee Y, Al-Hashmi K, Al-Hinai A. Saphenous vein graft vs. radial artery graft searching for the best second coronary artery bypass graftJ Saudi Heart Assoc. 2013;25(4):247–254. doi:10.1016/j.jsha.2013.06.001

  12. Punjabi PP, Taylor KM. The science and practice of cardiopulmonary bypass: From cross circulation to ECMO and SIRSGlob Cardiol Sci Pract. 2013;2013(3):249–260. doi:10.5339/gcsp.2013.32

  13. Aydin S, Aydin S, Nesimi Eren M, et al. The cardiovascular system and the biochemistry of grafts used in heart surgery. Springerplus. 2013;2(1):612. doi:10.1186/2193-1801-2-612

  14. Azarfarin R, Ashouri N, Totonchi Z, Bakhshandeh H, Yaghoubi A. Factors influencing prolonged ICU stay after open heart surgeryRes Cardiovasc Med. 2014;3(4):e20159. doi:10.5812/cardiovascmed.20159

  15. Cove ME, Spelman DW, MacLaren G. Infectious complications of cardiac surgery: a clinical reviewJ Cardiothorac Vasc Anesth. 2012;26(6):1094–1100. doi:10.1053/j.jvca.2012.04.021

  16. Mampuya WM. Cardiac rehabilitation past, present and future: an overviewCardiovasc Diagn Ther. 2012;2(1):38–49. doi:10.3978/j.issn.2223-3652.2012.01.02

  17. Institute of Medicine (US) Committee on Social Security Cardiovascular Disability Criteria. Cardiovascular Disability: Updating the Social Security Listings. Ischemic heart disease. Washington (DC): National Academies Press (US); 2010.

  18. Parker RD, Adams J. Activity restrictions and recovery after open chest surgery: understanding the patient's perspectiveProc (Bayl Univ Med Cent). 2008;21(4):421–425. doi:10.1080/08998280.2008.11928442

  19. Coyan GN, Reeder KM, Vacek JL, Coyan GN, Reeder KM, Vacek JL. Diet and exercise interventions following coronary artery bypass graft surgery: a review and call to actionPhys Sportsmed. 2014;42(2):119–129. doi:10.3810/psm.2014.05.2064

  20. Hawkes AL, Nowak M, Bidstrup B, Speare R. Outcomes of coronary artery bypass graft surgeryVasc Health Risk Manag. 2006;2(4):477–484. doi:10.2147/vhrm.2006.2.4.477

Additional Reading