Coronary artery bypass surgery is a procedure to treat coronary heart disease. There are various types, including multiple bypass and minimally invasive.

The medical name for coronary artery or heart bypass surgery is coronary artery bypass graft (CABG).

The procedure involves removing a blood vessel from the chest, arms, or legs and using it to create a detour or bypass around the blockage in the coronary artery that feeds the heart. This allows blood to reach the heart again.

Heart bypass surgery is a relatively safe and effective procedure that reduces the risk of heart attack and death. The procedure might also ease symptoms of coronary artery disease, such as chest pain.

Read on to learn more about the types of coronary artery bypass surgery and what it involves. This article also looks at possible risks, success rates, and more.

There are different types of bypass surgery, including:

  • multiple bypass surgery
  • minimally invasive bypass surgery
  • on-pump bypass surgery
  • off-pump bypass surgery

Multiple bypass surgery

When a surgeon only has to bypass a single blocked artery, this is a single bypass operation. If more than one artery has a blockage, multiple bypasses will be necessary. These include:

  • Double bypass surgery: If there are blockages in two arteries, then two grafts will be necessary.
  • Triple bypass surgery: If there are three blockages, then three bypass grafts are necessary.
  • Quadruple bypass surgery: If four coronary arteries contain blockages, then four grafts are necessary to bypass them.
  • Quintuple bypass surgery: This involves bypassing 5 different areas of coronary arteries feeding the heart.

Minimally invasive bypass surgery

Surgeons can perform heart bypass surgery without fully opening a person’s chest. They can make small incisions in a person’s side, between the ribs. They then insert small cameras and surgical instruments to carry out the bypass surgery.

Surgeons may perform this with or without robotic assistance.

Minimally invasive heart surgery may haveTrusted Source a shorter recovery time. The procedures can produce results that are as positive as open surgery.

On-pump and off-pump

Heart bypass surgery is typicallyTrusted Source an open-heart surgery, which means the surgeon cuts the chest open to reach the heart. The surgeon can then perform the surgery “on-pump” or “off-pump.”

On-pump surgery involves using a heart-lung machine that circulates blood and performs the gas-exchange function of the lungs. The machine allows doctors to stop the heart, which makes the operation easier.

Off-pump surgery, also called “beating heart surgery,” takes place while the heart is still beating but does not use the heart-lung machine.

The stages of coronary artery bypass surgery may depend on the type of surgery. The stages of an open bypass procedure are as followsTrusted Source:

  1. General anesthesia: After preparing for the surgery, an anesthesiologist will administer a general anesthetic to put the person to sleep and place a breathing tube into the person’s windpipe.
  2. Harvesting of graft vessels: Surgeons will remove target vessels from the person’s leg, arm, or chest.
  3. Incision and opening: The surgeon will make an incision in the center of the chest and separate the person’s sternum to access the heart. For on-pump surgeries, they will temporarily stop the heart from beating at this point.
  4. Cardiopulmonary bypass: Doctors may place a person on a cardiopulmonary bypass. This involvesTrusted Source connecting the person to a machine that takes over their heart and lung processes. Not all surgeries require the use of this bypass.
  5. Grafting: Surgeons will attach the new graft vessels to either side of the blockages to divert blood flow.
  6. Restoring blood flow: Doctors will remove the cardiopulmonary bypass if necessary and then check that blood is flowing through the grafted vessel correctly.
  7. Closure: After checking blood flow through the graft, the surgeons will fix the sternum with metal wires and sew up the incision site. The person will move to an intensive care unit for recovery.

The procedure typically takes 3 to 6 hoursTrusted Source, but this can vary depending on how many grafts a person requires.

Before coronary artery bypass surgery, people should:

  • stop smoking immediately, if applicable
  • discuss with the surgeon which medications to continue or discontinue
  • arrange for someone to stay with them after returning home
  • avoid eating or drinking as a doctor instructs, usually at least 6 hours before surgery
  • follow any other instructions provided by the doctor or care team

A person undergoing a planned heart bypass operation will have an opportunity to discuss the procedure with their doctor before the operation. The care team will explain the surgery, set arrival times, and help complete paperwork.

They will also undergo testsTrusted Source before the surgery, including an electrocardiogram (EKG), chest X-ray, additional imaging tests, and blood tests.

Before the operation, nurses insert an IV into the person’s arm. The IV will allow fluids and medication to enter the body as needed.

A member of the healthcare team might also shave the areas where a surgeon will make their incisions.

Risks and potential complications vary for each person. This will depend on the type of procedure performed, personal health, and personal risk factors.

Potential complicationsTrusted Source of a heart bypass include:

Having emergency surgery, such as for a heart attack, may increase the likelihood of complications. Having certain underlying conditions, such as diabetes or peripheral artery disease (PAD), may also increase the risk.

Heart bypass surgeries are a serious procedure but relatively safe.

The outcomes of these procedures are typically positive. According to Columbia Surgery, they have an overall success rate of almost 98%.

However, it is important to note that the outcome can depend on factors such as the individual’s overall health. A person’s doctor can provide them with more information about what their outcome may be.

A person will usually need to stay in the hospital for around 7 days after coronary artery bypass surgery.

After waking up from coronary artery bypass surgery, a person will have a tube that helps them to breathe until they are able to breathe on their own.

There will also beTrusted Source tubes and drains in the chest, as well as external monitors on the skin. The healthcare team will monitor the output from these devices and remove them when appropriate. They will also monitor blood pressure.

It is typical to experience soreness, and there is likely to be some fluid in the lungs, so people should expect coughing.

People usually start to eat and move around soon after the doctor has removed the breathing tube.

Common postsurgery medications typically include platelet inhibitors, which help prevent blood clots. Doctors may also prescribe additional medications to help control heart rate and blood pressure.

Physical therapy and cardiac rehabilitation may also be necessary for recovery.

Coronary artery bypass surgery, or coronary artery bypass graft (CABG), is a major procedure for treating blocked blood vessels in the heart. It is generally safe and can help people regain the quality of life they experienced before they developed a heart condition.

There are different types of coronary artery bypass surgery. A person’s doctor can advise on what type they recommend, as well as what to expect before, during, and after the procedure.