What is bypass surgery?
A bypass operation generally refers to the surgical creation of a bypass around a narrowed or blocked blood vessel. Bypass procedures are used in various medical fields, such as for circulatory disorders in the legs or for coronary artery disease. This page is about aortocoronary bypass surgery, a procedure performed on the heart to treat diseased coronary arteries.
Bypasses are placed in the coronary arteries to improve the restricted blood flow to the heart muscle due to calcified, narrowed or even blocked coronary arteries with other blood vessels. The blood vessels used to bypass the diseased coronary vessels are taken from the patient. Arteries from the chest wall and/or from the forearm or veins from the leg are mainly used. With the help of these new vascular connections, the heart muscle is once again supplied with sufficient oxygen-rich blood.
When is bypass surgery performed?
Coronary artery bypass surgery is particularly an option for patients with coronary artery disease when the coronary arteries are narrowed or blocked by plaque, impairing blood flow to the heart muscle. Common symptoms include chest pain or a feeling of tightness in the chest (angina pectoris), shortness of breath, and reduced physical endurance. Bypass surgery may also be recommended following a heart attack or in cases of severe narrowing of multiple coronary arteries.
The goals of treatment are to eliminate or alleviate symptoms such as chest pain and tightness, to help patients regain a normal lifestyle and age-appropriate functional capacity, and to prevent heart attacks or other heart problems, such as arrhythmias.
Modern Bypass Surgery at the USZ
Before bypass surgery, the coronary arteries and heart function are carefully examined to determine the optimal treatment plan. The procedure is performed under general anesthesia and is supported by a specialized team of cardiac surgeons, anesthesiologists, and intensive care specialists.
If indicated, the procedure is performed using a minimally invasive approach (MIDCAB). In certain cases, treatment may also be performed using a hybrid approach, which combines bypass surgery with a catheter-based procedure (stent placement).
The use of state-of-the-art heart-lung machines makes it possible to reduce the use of external blood and speed up recovery after the procedure. The duration of the surgery depends on the number of affected coronary arteries and the complexity of the procedure.
If necessary, we also perform bypass operations in combination with other cardiac interventions. The choice of the appropriate procedure is made on a case-by-case basis through an interdisciplinary approach following a consultation among specialists in cardiac surgery and cardiology within the Heart Team.
Bypass or Stent: Which Treatment Is an Option?
Both bypass surgery and stent placement are used to treat narrowed or blocked coronary arteries and improve blood flow to the heart muscle. The appropriate method depends, among other things, on the number, location, and severity of the narrowed blood vessels, as well as on the patient’s overall health and any underlying medical conditions.
A stent is implanted during a catheter procedure and is often suitable for isolated or less complex narrowings of blood vessels. Coronary artery bypass surgery is particularly indicated in cases of severe or multiple narrowings of the coronary arteries and can lead to a long-term improvement in blood flow. Even in patients with knowndiabetes mellitus or heart failure, bypass surgery is more likely to be performed than stent placement.
At the USZ, the decision regarding the appropriate treatment is made through an interdisciplinary approach by specialists in cardiology and cardiac surgery. This process takes into account the individual circumstances and the long-term prognosis for treatment.
What procedures do we offer?
At the USZ, we offer the full range of modern bypass surgery, including:
- Aortocoronary bypass surgery (ACBP): A standard procedure to bypass narrowed or blocked coronary arteries in order to restore blood flow to the heart muscle.
- Purely arterial revascularization of the coronary arteries: bypass surgery using only arterial vessels, with the goal of ensuring long-term patency of the bypasses.
- Enlargement of the Left Ventricular After a Heart Attack (Cardiac Aneurysm): Surgical treatment of bulges in the left ventricle that can develop after a heart attack.
- Treatment of Traumatic Heart Injuries: Surgical Management of Injuries to the Heart and Adjacent Vessels.
- Correction of Congenital Coronary Artery Malformations in Adults: Treatment of rare congenital abnormalities of the coronary arteries that cause symptoms or may increase the risk of complications.
Recovery and Rehabilitation After Bypass Surgery
After bypass surgery, patients are first cared for in the intensive care unit and then transferred to a specialized inpatient unit. Gradual mobilization begins under medical supervision shortly after the procedure.
As a general rule, we recommend inpatient cardiac rehabilitation. Depending on the individual’s specific course of recovery, outpatient rehabilitation may also be recommended. Rehabilitation in general helps patients rebuild their physical abilities and prepare for a return to everyday life. Questions regarding a return to work or participation in sports are also discussed on an individual basis as part of the follow-up care.
During the recovery phase, the treating specialists closely monitor patients and support them as they take the next steps toward returning to their daily lives.
Long-Term Prognosis and Quality of Life
Bypass surgery can significantly improve blood flow to the heart muscle and reduce symptoms such as chest pain or limitations in physical activity. Many patients benefit in the long term from an improved quality of life and greater resilience.
The individual prognosis depends on various factors, including the severity of the heart disease, heart function, and any underlying medical conditions. Regular follow-up visits and consistent management of risk factors help ensure long-term treatment success.
Frequently Asked Questions About Bypass Surgery
The duration of bypass surgery depends on the number of affected vessels and the complexity of the procedure. In many cases, the surgery takes several hours.
In traditional bypass surgery, the chest is opened along the sternum to gain access to the heart. In certain cases, minimally invasive procedures may also be an option.
Bypass surgery is one of the more extensive cardiac surgical procedures and requires careful planning and follow-up care. Thanks to modern surgical techniques and specialized treatment teams, it is now routinely performed. It is also the most common type of heart surgery.
A stent is inserted during a catheter procedure to keep a narrowed blood vessel open from the inside. In bypass surgery, the narrowed section is bypassed using a blood vessel from the patient’s own body. The appropriate treatment depends on the individual situation.
Like any surgical procedure, bypass surgery also carries risks. These include, among other things, bleeding, infections, cardiac arrhythmias, or, in rare cases, more serious complications. Before the procedure, the treatment team provides a detailed explanation of the possible risks.
The length of stay depends on the individual’s health and the course of recovery. After being monitored in the intensive care unit, patients receive further care in a specialized inpatient unit. On average, we expect a one-week hospital stay.
Recovery varies from person to person and depends on a number of factors. Many patients participate in cardiac rehabilitation after surgery to gradually rebuild their physical fitness.
When you will be able to drive again depends on your recovery and your individual circumstances. The treating physicians will provide information about the appropriate timing and any possible restrictions. It is also a good idea to contact your insurance company before you start driving again. The point in time at which driving is permitted again from a medical standpoint does not always align with the requirements under insurance law. Clarifying this early on helps avoid any potential uncertainty regarding insurance coverage.
During the first few weeks after surgery, you should avoid physical exertion and activities that could interfere with wound healing. The treating specialists provide personalized recommendations for returning to daily life, work, and sports.
After the recovery period, many patients experience improved physical endurance and a higher quality of life. Long-term success depends, among other things, on heart function, any underlying medical conditions, and consistent follow-up care.
Thanks to modern surgical techniques and comprehensive medical care, the chances of survival after bypass surgery are good in many cases today. However, the individual prognosis depends on factors such as age, comorbidities, and the severity of the heart disease.
Bypass surgery can improve blood flow to the heart muscle over the long term and help reduce symptoms. How long a person lives after the procedure depends on many individual factors and cannot be predicted in general terms