Coronary arteries are blood vessels that wrap around the heart muscle and keep it supplied with oxygen-rich blood.  The left ventricle pumps blood forcing it into the body's largest artery, the aorta, located at the top of the heart.  Two coronary arteries, the left main artery and the right coronary artery, branch off the aorta.

The left main artery is about as wide as a drinking straw and less than an inch long.  It branches into two narrower arteries: the left anterior descending, which travels down the front side of the heart, and the left circumflex, which circles around the left side and then to the back of the heart.  The right coronary artery branches from the aorta, circles around the right side and then to the back of the heart.  These arteries are on the outside surface of the heart.  They divide into smaller branches, similar to a tree, and go deep into the heart muscle carrying oxygen-rich blood to the cells.

Diagnosing your problem.

If you have a blockage in one or more of your arteries, the blood supply to your heart is compromised.  Chest pain, chest discomfort, arm pain, or other symptoms you may experience could be warning signs that your heart muscle is not getting enough blood.  If the compromise persists, you could suffer a heart attack and the muscle might be damaged.

What causes a blocked artery?

Atherosclerosis is the buildup of fatty deposits on the inside of the arteries.  They become narrow and reduce the blood flow to the heart (like a clogged drain).

Where does atherosclerosis come from?

Cholesterol is a necessary component of the human cell; but, over time, cholesterol in the blood can become deposited on the inside walls of arteries.  This process of deposit seems to happen faster in people who:

• Smoke
• Have high blood pressure
• Eat high fat, high cholesterol foods, or, for other reasons, have high cholesterol
• Are overweight
• Have a lot of tension and stress
• Do not exercise regularly
• Have diabetes and/or family members with a history of atherosclerosis.

How is it determined I need surgery?

A cardiac catheterization may be done.  Pictures, called angiograms, are taken to show the blockages.

What is bypass surgery?

There are several types of cardiac surgery. CABG (sounded out as cabbage), coronary artery bypass graft is an operation in which other blood vessels are used to go around, or bypass, clogged coronary arteries. Blood can then flow freely to the heart through the new arteries.During surgery,  the heart is temporarily stopped while a pump continues to circulate blood to the body.   A newer procedure, OPCAB (off-pump coronary artery bypass),  is done through the same type of surgical incision but without stopping the heart and without using the special perfusion pump.

How do I prepare for surgery?

Rest, eat a healthful diet, quit smoking, and walk or do the exercise allowed by your doctor.  Some routine tests may be done before surgery: EKG, echocardiogram, chest x-ray, blood tests, medical history and exam.  Make a list of any questions you have so that your doctor can answer them for you.  Your doctor can provide instructions before surgery to prepare you for the procedure.

What happens the day of the bypass surgery?

Generally, the morning of surgery you will be given medication to make you feel relaxed and drowsy.  You will be taken to surgery and will be in the operating area for several hours.  Cardiac bypass surgery usually is two to five hours.   

The surgeon takes a blood vessel from your arm or leg and attaches one end to the aorta (the large artery that comes out of the heart) and the other end to the coronary artery below the point where it is blocked -- this is the bypass.  A blood vessel from within the chest also may be used to create the bypass.  Blood can then flow freely through the new bypass graft to the heart.

What happens to the blockage?

The blockage remains as is.  The blood supply has been rerouted around it to the heart muscle.

What are the risks?

Almost half a million bypass surgeries are performed each year.  As in all major surgery, there are risks.  There is potential complication of stroke, bleeding, infection and heart attack during or after surgery.  After review of your medical history and a physical exam, your surgeon can identify your risks.

How will I feel after my bypass?

When you wake up (usually in the Intensive Care Unit), you may feel confused at first.  Your family may visit briefly.  Be assured you are in capable, caring hands.  You may be uncomfortable and unable to talk, but the nurses will help you communicate.  The purpose of equipment surrounding you is to help you breathe; measure heart function; and check your blood pressure, heart rate, and kidney function.  After all your vital signs are stable, you may sit in a chair.

Most of the tubes and catheters may be removed within a day or two, and you can be moved to a regular room or discharged.  You will be asked to take deep breaths.  You will feel sore.  This is normal.  The surgeon may prescribe medication to keep you comfortable.  If you are in pain, don't hesitate to tell your nurse or doctor.

The nurses will have you moving and walking around as soon as possible.  Generally, within a day you may eat a normal meal and begin to feel better each day.

What can I do when I return home?

Your surgeon and the hospital staff can discuss any restrictions you may have. 

Follow-up visits with your doctor are generally scheduled for one week and six weeks after surgery.  You may be instructed to make some changes in your lifestyle such as reducing your consumption of fat and cholesterol, and exercising daily.  Discuss with your doctor when you can resume your normal activities.

The majority of patients have perceptible relief of their symptoms after surgery.  Some notice an increase in their energy level after recovery.  Although symptoms may recur, many patients experience sustained relief.

This information is provided as a general overview of coronary artery bypass surgery.  It is not intended as a substitute for discussion with your doctor.

Return to Bay Area Heart Institute.