1- The patient is brought to the operating room and moved onto the operating table.
2- An anesthetist places a variety of intravenous lines and injects an induction agent (usually propofol) to render the person unconscious.
3- An endotracheal tube is inserted and secured by the anesthetist or a respiratory therapist and mechanical ventilation is started.
4- The chest is opened via a median sternotomy and the heart is examined by the surgeon.
5- The grafts are harvested - frequent conduits are the internal thoracic arteries, radial arteries and saphenous veins.
6- The surgeon stops the heart and initiates cardiopulmonary bypass; or in the case of "off-pump" surgery, places devices to stabilize the heart.
7- One end of each graft is sewn onto the coronary arteries beyond the blockages and the other end is attached to the aorta.
8- The heart is restarted; or in "off-pump" surgery, the stabilizing devices are removed. In some cases, the Aorta is partially occluded by a C shaped clamp, the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating. This reduces time spent on the heart lung machine.
9- The sternum is wired together and the incisions are sutured closed.
10- The person is moved to the intensive care unit (ICU) to recover. After awakening and stabilizing in the ICU (approximately 1 day), the person is transferred to the cardiac surgery ward until ready to go home (approximately 4 days). Video
After Surgery
After bypass surgery, you should limit the fat and cholesterol in your diet. Your doctor may recommend walking or swimming to get your strength back. Your doctor may also recommend that you join a cardiac rehabilitation program. These programs can help you make lifestyle changes such as starting a new diet and exercise program, quitting smoking, and learning to better deal with stress.
If you have an office job, you can usually go back to work in 4 to 6 weeks. Those who have more physically demanding jobs may need to wait longer. In some extreme cases, you may need to find a job that is not as physically demanding. Twenty to 30% of bypass patients will need a second procedure within 10 years
