Coronary Bypass (Standard Incision)
What is Coronary Bypass Surgery?
In the standard technique of heart surgery, the breastbone is cut from top to bottom in the middle to open the chest cavity. The patient is connected to a heart-lung machine, the heart is stopped with a special solution, and the bypass procedure is performed. In suitable patients, this procedure can also be done while the heart is still beating (without stopping it). Coronary bypass surgery is the process of bypassing the narrowed part of the coronary artery with another vessel to maintain continuous blood flow. The vessel taken from another part of the body is called a “graft.” Both artery and vein grafts can be used. Arterial grafts may include the internal mammary artery, radial artery, abdominal wall artery, and gastric artery. Vein grafts are usually taken from the legs (rarely from the arm). The vein taken from the leg is responsible for only about 10% of the leg’s blood circulation, so removing this vein does not affect walking or normal leg functions. After surgery, swelling may occur in the related leg for a while; it is resolved by elevating the leg and using compression stockings. Like all surgical procedures, coronary bypass surgery carries certain risks. The risk level depends on the patient’s age, general health, smoking status, presence of additional diseases, and heart function. Under the best conditions, this risk is 1% or less. A successful coronary bypass surgery eliminates symptoms related to coronary artery disease (such as chest pain), improves heart perfusion whether symptomatic or not, and prolongs the patient’s life.
Coronary bypass is a surgical procedure performed to overcome blockages in the arteries supplying the heart. During this operation, the patient’s own vessels are used to create a “bridge” over the blockage area, restoring blood flow.
How is Coronary Bypass Surgery Performed?
Coronary bypass surgery can be performed using two different techniques:
1. Bypass on a Stopped Heart
The heart is temporarily stopped.
The body’s circulation is maintained by a heart-lung machine.
This system ensures oxygenated blood is pumped to the organs throughout the surgery.
2. Bypass on a Beating Heart
The procedure is performed without stopping the heart.
No heart-lung machine is used.
It results in less bleeding and a shorter recovery period.
In both methods, the preferred surgical technique is determined based on the patient’s overall condition, vessel structure, and other medical factors. In some cases, this surgery can also be performed using a minimally invasive (endoscopic) method.
Which Vessels Are Used?
Vessels can be taken from different parts of the body for bypass:
Internal mammary artery (IMA): Taken by cutting the breastbone.
Saphenous vein: Removed through an incision on the inner part of the leg.
Radial artery: Usually used as a second choice..
One end of the harvested vessel is sewn below the blocked coronary artery, and the other end is attached to an open artery to redirect blood flow.
Who Is a Candidate for Bypass?
Coronary bypass surgery is preferred in the following cases:
Multiple vessel blockages
Recurrent blockage despite previous stent placement
Coronary issues combined with heart valve diseases
Vessels that cannot be opened by non-surgical treatments
Advanced coronary disease impairing heart functions
How Long Does the Surgery Take?
The duration of coronary bypass depends on:
Whether the surgery is open or minimally invasive,
The number of vessels involved,
Whether the heart is stopped or beating during surgery.
It generally takes between 3 to 6 hours. The time may increase if additional heart procedures (e.g., valve replacement) are performed simultaneously.
What Are the Risks of Surgery?
Bypass surgeries have become quite safe nowadays, but there are risk factors:
Age: Risk increases with advanced age
Chronic diseases: Diabetes, kidney failure, hypertension
Heart history: Previous heart attack or heart muscle damage
Surgical risks: Infection, bleeding, stroke risk
All these risks are minimized through detailed preoperative evaluation.
Is Bypass Surgery a Permanent Solution?
Coronary bypass creates a new path around the blocked artery to restore blood flow. However, it does not eliminate artery hardening. Therefore:
Lifestyle changes are essential
Healthy eating, exercise, and quitting smoking must be adopted
Medications should be taken regularly
Otherwise, new grafts can also become blocked over time, and another surgery may be needed.
Post-Surgery Recovery Process
The recovery process generally proceeds as follows:
First 24-48 hours: Patient is monitored in intensive care.
3-7 days: Patient is discharged if stable.
1 week later: Follow-up examination.
1 month later: Gradual return to normal life.
Within 6 months: Breastbone and tissue healing complete.
Including patients in physical therapy and rehabilitation is very important for heart health during recovery.
How Should Life Be After Surgery?
To improve quality of life and prevent new artery blockages after bypass surgery, attention should be paid to:
Quit smoking
Regulate diet (low salt, low fat, balanced)
Lose excess weight
Do light exercises
Maintain regular sleep and stress management
Do not skip cardiology check-ups
Light sports such as swimming, hiking, and table tennis support the recovery process.
Sıkça Sorulan Sorular
The post-surgery recovery process varies between patients, but most are discharged within 1 week. Return to normal life usually takes 4-6 weeks, while full physical recovery may take approximately 3-6 months.
Yes, if lifestyle changes are not made, new vessels can become blocked over time. Smoking, unhealthy diet, inactivity, and uncontrolled diabetes increase this risk. Therefore, regular follow-up and a healthy lifestyle are very important.
Not always. Bypass surgery can be performed on both a stopped heart and a beating heart. The choice of method depends on the patient’s condition and the surgeon’s decision.
When blockages are opened, the heart muscle receives more oxygen, which generally leads to a reduction in symptoms and improvement in heart function. However, the heart’s full recovery depends on the damage caused by the blockage.
Light physical activities can generally be started after 2-3 weeks. Activities like driving are recommended after 1 month, and returning to work after 1.5 to 2 months. However, the full recovery time varies depending on individual circumstances.