Purpose:
A heart bypass surgery is performed in case of the presence of a blocked artery to the heart. It may be done in the following situations:

• Severe chest pain
• More than one diseased coronary artery
• Left ventricle (the main pumping chamber of the heart) is not functioning well
• The main coronary artery is blocked or severely narrowed
• Artery blockage that cannot be treated by angioplasty (a procedure of temporarily inserting and inflating a tiny balloon for widening the artery)
• History of a failed angioplasty
• History of a failed stent placement procedure (a small mesh wire tube is inserted to keep the artery open)
• Heart attack

1. Physical examination: The doctor examines the patient physically. The symptoms, medical history, and family history of the patient are noted.
2. Blood tests: This test helps in evaluating the overall well-being of the patient, and to check for any underlying abnormalities.
3. Urine tests: This test helps to check if there are any underlying infections.
4. Chest x-ray: This test helps in evaluating the condition of the heart and lungs.
5. Electrocardiogram (ECG): This test helps in recording the electrical activity of the heart.
6. Coronary angiogram: This is a test done to check for any blockage in the coronary artery.

A heart bypass surgery takes approximately three to six hours to complete.
It is generally performed under general anesthesia, that is, the patient is put to sleep during the procedure.
The number of bypasses done depends on where in the heart the blockage is and how severe it is.
A heart bypass surgery can be done in the following ways:

1. Open-heart surgery:

• A long incision or cut is made in the chest area by the surgeon in this procedure.
• This type of surgery can be performed in the following ways:
• On-pump heart bypass surgery:
• The surgeon cuts down the center of the chest along the breastbone. The rib cage is spread open to expose the heart.
• Once the chest is opened, the heart is stopped temporarily with medication and a heart-lung bypass machine, that takes over the function of the heart and lungs and circulates blood to the rest of the body.
• A section of a healthy blood vessel is taken by the surgeon, usually from the lower leg or from inside the wall of the chest.
• The ends of the healthy blood vessel are attached above and below the blocked artery to redirect the blood flow around the narrow part of the diseased artery.
• After the completion of the graft, the heartbeat is restored and the patient is disconnected from the heart-lung machine.
• A wire is used to close the chest bone. This wire remains in the body after the bone heals.
• The incision in the chest region is then closed using sutures (stitches).
• Off-pump or beating-heart surgery:
• This procedure involves performing the surgery on a beating heart using special equipment to stabilize the area of the heart which is being operated on.
• This is a challenging type of open-heart surgery since the heart is still moving while performing this surgery.

2. Minimally-invasive surgery:

• The procedure is done by making small key-hole incisions in the chest region.
• The procedure can also be performed using robotic arms that are guided by the surgeon.

The possible complications of a heart bypass surgery may include:

• Bleeding
• Infection
• Blood clot formation
• Allergic reaction to anesthetic agents
• Arrhythmias (irregular heart rhythms)
• Memory loss
• Trouble in thinking clearly
• Kidney problems
• Heart attack
• Stroke (a condition in which the blood supply to the brain is interrupted)

There will be some wires and a breathing tube connected to the patient after the surgery. They are normally removed after two days.
The patient is usually kept in the hospital for five to seven days after the procedure.
It is normal to feel some pain and stiffness in the chest after the procedure.
The doctor may prescribe medications to relieve the pain and discomfort.
Follow-up appointments with the doctor can help you in discussing medications, wound care, and physical activity.
The doctor may advise you to attend a cardiac rehabilitation program, which is a supervised exercise and nutrition program that will help you in recovering from the surgery.
It is normal to have a loss of appetite and constipation after the surgery.
In case of the removal of a healthy vein from the leg, it is normal to have some swelling in that area after the procedure.
You may be able to return to your daily activities 6 weeks after the surgery.
Avoid driving for 4 to 6 weeks after the surgery.
Avoid sexual activity for at least 3 weeks after the surgery.
Complete recovery may take 2 to 3 months.