What Is a Triple Bypass Heart Surgery?

Understanding Heart Bypass Surgery

Anesthesiologist holding oxygen mask over patients face in operating room
Heart Surgery Starts With General Anesthesia. Caiaimage/Robert Daly/Getty Images

Triple bypass heart surgery is an open heart surgery that is done when the blood vessels that feed the heart are too clogged to function properly. This type of heart surgery is usually performed as an open heart procedure, meaning the surgeon opens the chest in order to see the heart and perform surgery.  

The surgery can be performed as a minimally invasive procedure where the chest is not opened.

 That procedure, which is less common than the more standard open heart surgery, as far less patients are physically appropriate for that technique.

Anatomy of the Human Heart

To understand a triple bypass procedure, it is essential to understand a few things about the anatomy of the heart and heart disease.  The blood vessels that supply the heart with its own blood supply are called the coronary arteries.   In some people, the coronary arteries become blocked, a condition known as coronary artery disease.

If a blockage is severe, it can completely stop blood flow to the area of the heart that is fed by that particular blood vessel. Stopping the blood flow to the heart is extremely serious--even in the smallest of blood vessels--because it can cause chest pain, a heart attack or even death.

Double, Triple, Quadruple or Quintuple Bypass

The number of vessels that are diseased typically dictates the number of grafts--vessels that need bypasses--that will be performed.

If three vessels are blocked and need to be bypassed, the surgery is referred to as a triple bypass because three grafts are performed. If two vessels are bypassed the surgery is called a double bypass, and so on.  Quintuple bypass procedures, where five vessels are bypassed, are fairly rare, but the four vessel quadruple bypass is fairly common.

 

In addition to the risks of general anesthesia, the risks associated with an open heart procedure increase with the number of bypasses required, as the surgery takes longer and the coronary artery disease being treated is more severe.  

During Triple Bypass Heart Surgery

In many cases, coronary artery disease can be treated with medication, lifestyle changes and less invasive procedures such as the placement of stents. However, for some patients the blockage(s) are so severe that surgery is necessary to make sure the heart continues to receive adequate blood flow. This procedure is known as coronary artery bypass graft surgery (CABG).

Performed under general anesthesia, the procedure starts with blood vessels being taken from another area of the body, typically the leg and the left side of the chest.  The vein harvesting is often done by one healthcare provider such as a Physician Assistant (PA), while the chest portion of the procedure is done by a cardio thoracic surgeon at the same time.

These vessels are then sewn onto the existing heart vessel before and after the blockage. It is not unlike a quick detour your car takes to avoid an accident, with the blood literally being routed around the blocked vessel.

 

This entire procedure open heart portion of the procedure is usually done using a heart lung bypass machine, which is a complex machine that does the work of the heart and lungs during surgery.  The surgeon works quickly to limit the amount of time the patient spends "on pump" to minimize potential complications. 

The use of this machine typically requires ample fluid and often donated blood to compensate for the amount of blood and fluid leaving the body, being oxygenated, then returned to the body.  For that reason, many individuals find that they have temporarily gained a few pounds and may find that they are slightly "puffy" in the days following surgery.

 Once the patient is up and moving, this excess fluid leaves the body in the form of urine. 

Once the surgeon has finished the procedure, chest tubes are placed to drain fluid that might otherwise build up around the heart and prevent the heart from functioning well or from healing taking place.  These tubes are typically removed within a few days of surgery.  The sternum (breastbone) is sewn together using a special surgical wire and the skin is closed with sutures or staples.

After Heart Bypass Surgery

Unlike most surgeries, the patient is allowed to wake slowly and naturally from anesthesia, rather than a medication being given to wake the patient up.  For this reason, it is often 4 to 6 hours after surgery before the patient begins to be awake and alert, and the breathing tube remains in place until that time. The first day after surgery is typically spent in a cardiac care unit or ICU, where the nurses can keep a watchful eye over the patient as they begin their recovery.

For most patients, the goal for the first 12 hours of surgery is not only to wake up and have the breathing tube removed, but to be up in a chair and taking a few steps and sitting up in a chair at least once and preferably twice.  This process is aimed at not only starting the recovery process, but preventing serious complications like blood clots and pneumonia.  

Recovery After Heart Bypass Surgery

The recovery from this type of procedure will take several days in the hospital and several months after returning home.  For some, recovery will include cardiac rehabilitation--physical exercise performed under the watchful eye of a therapist--to help strengthen the heart.  For most, recovery will take 6 to 12 weeks, and will end with a return to the activities that were enjoyed prior to surgery.  For some, they will be able to do more activities, as their exercise will not be limited by chest pain.

Sources:

What Is Coronary Artery Bypass Grafting? National Heart Lung and Blood Institute. Accessed May, 2017. http://www.nhlbi.nih.gov/health/dci/Diseases/cabg/cabg_whatis.html

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