What Is Quadruple Bypass Heart Surgery?

Understanding Quadruple Bypass Open Heart Surgery

heart chamber and valves
Surgeon Explains Open Heart Surgery. asiseeit/iStockphoto

A quadruple bypass is an open heart surgical procedure that is done to improve the blood flow that feeds the heart. Many people are diagnosed with heart disease--and the need for surgery--after experiencing chest pain, shortness of breath or common symptoms like arm or jaw pain. 

To really understand what is means to have a quadruple bypass, it is essential to understand the anatomy of the heart and effects of heart disease.

 

Coronary Artery Disease and Quadruple Bypass Surgery

The coronary arteries are the blood vessels that supply the heart with its own blood supply; these are different than the vessels that supply the blood pumped by the heart. To be clear, the heart pumps blood to the entire body through muscular contractions that keep blood moving.  The heart, like every tissue of the human body, also needs to be fed oxygen and nutrients from the bloodstream.  The blood vessels that feed the heart what it needs are called the coronary arteries and their small size can contribute to their becoming clogged easily with plaque. 

We care about the coronary arteries so much because, in some people, the coronary arteries become blocked--a condition known as coronary artery disease--where plaque builds up in the blood vessel.

If the blockage in the coronary artery is severe, it can prevent blood flow to the part of the heart that is fed by the diseased blood vessel, causing chest pain, also known as angina.

 If the blockage is severe enough, and the blood flow is dramatically decreased or completely stopped, a heart attack is typically the result. It is possible to have several arteries blocked in this manner, which can pose a significant risk to the heart.  

A quadruple bypass is performed when four blood vessels are blocked and need to be bypassed.

 This means four different blockages require blood to be rerouted around them.

Treatment For Coronary Artery Disease

In many cases, coronary artery disease can be treated with medication, lifestyle changes and less invasive procedures such as angioplasty.  When it cannot be treated with less invasive treatments, or those treatments don't stop damage from being done to the heart or chest pain continues, it is often appropriate to consider coronary bypass surgery.

Surgery has greater risks than less invasive procedures, including the risk associated with general anesthesia and the risks of open heart surgery, so this procedure is typically only an option if the disease is severe or does not respond to other types of treatment.  The quadruple bypass surgery is a complicated procedure, and the risks of surgery increase with each additional bypass graft.  For example, the double bypass surgery is less risky than a triple, and a triple is less risky than a quadruple bypass.  With each additional bypass that is needed the surgery is longer, require more time under anesthesia, and is being done to treat more severe disease. 

During Quadruple Bypass Surgery

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), or heart bypass surgery. 

The procedure starts with general anesthesia being administered while the surgeon or another healthcare provider, such as a Physician Assistant (PA) starts the procedure by harvesting veins from the extremities for the bypass grafts.  While the assistant is recovering the vessels--and once they are sure the vessels are of good enough quality to be used during the procedure--the cardio-thoracic surgeon opens the chest and begins preparing the heart for the procedure.  

The surgeon will also frequently take an additional vessel from the left chest to supplement the veins obtained from the leg, or in some cases, vessels from the arm.

 During the surgery, the recovered blood vessels are grafted onto the existing heart vessel before and after the blockage. It is not unlike a quick detour you might take to avoid an accident, with the blood literally being rerouted around the blocked portion of the vessel. 

During the vast majority of quadruple bypass surgeries the heart is stopped so that the surgeon is not working on a moving target. This is done by using a heart lung bypass machine, a complex medical device that supplies oxygen to the blood instead of the lungs and pumps it through the body as the heart would normally do.  This machine allows both the heart and lungs to be still and makes it possible to complete the graft portion of the surgery more quickly.

Recovery After Open Heart Surgery

The recovery from open heart surgery is not a quick one.  The first day after surgery is typically spent in the ICU or a cardiac care unit, where the patient is allowed to wake slowly from anesthesia.  Unlike other types of surgery, the patient is not given a medication to wake quickly, and instead sleep off the medication.  Ideally, the patient will be awake, off of the ventilator and sitting up in a chair at the bedside without 6 to 12 hours of surgery.  This is to decrease the risks of common issues such as blood clots and pneumonia, and to start the recovery process as quickly as possible. 

Open heart patients typically spend three or more days in the hospital prior to being discharged.  Some patients will require cardiac rehabilitation, a structured and monitored exercise program that is designed to strengthen the heart.  The typical recovery lasts 6 to 12 weeks, and most patients are able to return to their usual activities after their recovery is complete.  For patients who were limited in their activities by chest pain or fatigue caused by heart disease, they may find that they can better tolerate activity after surgery than before.

The major benefits to the patient will be most evident toward the end of the recovery phase, when activity can be done with no pain or less pain.  For some patients activity as simple as walking was limited by pain and heart disease prior to surgery and can be done without pain once the recovery phase has ended.  This does not mean that it is ok to rush into activities after surgery, but it does mean that some individuals are able to be more active after surgery.

It is also important during this recovery to actively work on lifestyle changes that will keep the new grafts open and performing well.  This means a heart healthy diet, with restrictions on saturated fat and cholesterol.  Exercise should also be included, within the instructions provided by the surgeon for the recovery period.  After recovery is complete these diet restrictions should continue, along with an exercise program.

Double, Triple and Quintuple Bypass Surgeries

The number of vessels that are severely blocked determines the number of grafts that will be performed during the procedure. If three vessels 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. Single bypasses are possible, but they are rare, as are quintuple bypass procedures where five vessels are bypassed.  

Sources:

What Is Coronary Artery Bypass Grafting? National Heart Lung and Blood Institute. Accessed 2009. http://www.nhlbi.nih.gov/health/dci/Diseases/cabg/cabg_whatis.html

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