Bypass: Procedure, Recovery & Life Expectancy

For individuals facing severe coronary artery disease, bypass surgery is a life-changing intervention. But what exactly does this complex procedure entail? In this in-depth interview, Peter Zombori sits down with Professor Jürg Grünenfelder, a distinguished heart surgeon from Hirslanden Zurich, to demystify bypass surgery, explore its techniques, compare it with other treatments, and discuss the realities of recovery and long-term life expectancy.

Peter Zombori: Welcome, everybody. Today's topic is bypass surgery, and with us is Professor Grünenfelder, heart surgeon from Hirslanden Zurich. Thank you, Professor. Can you give us a little insight into the bypass surgery procedure? What do you do, and how do you do it?

Prof. Jürg Grünenfelder: Yes, of course. Bypass surgery in cardiac surgery is performed on patients with coronary artery disease. If they have severe coronary artery disease and are not eligible or suitable for stenting, they undergo bypass surgery. Bypass surgery means we implant bypasses to the heart to allow blood to flow into the heart without being obstructed by the coronary arteries. These bypasses are created using arteries and veins from the patient's own body.

Peter Zombori: So you take them from somewhere else, basically.

Prof. Jürg Grünenfelder: Yes, we take them from elsewhere. The arteries are usually from inside the chest, called mammary arteries. We typically use both mammary arteries from inside the chest to create the bypasses. If necessary, we also use the saphenous vein, which is a vein in the leg.

The number of bypasses we need to place depends on the patient's anatomy and the extent of their disease. We can place these bypasses either with or without the heart-lung machine, depending on the patient's status. We perform this procedure very often; it's a very well-known and effective treatment for patients with coronary artery disease.

Peter Zombori: What is the reason why a certain patient would not be qualified for stenting?

Prof. Jürg Grünenfelder: This is always a big controversy within the medical community, between cardiologists and cardiac surgeons: what is the best treatment for a patient with coronary artery disease? Studies have shown that surgery is much better for patients with severe three-vessel disease, meaning all three coronary arteries are diseased. This has been demonstrated in many studies, especially if the patient also has diabetes; these patients fare much better with coronary artery bypass grafting (CABG).

Watch the full video here:

Prof. Jürg Grünenfelder: However, in other patients with such severe disease, stenting is considered the gold standard and is performed very often as a very good therapy. In these cases, we discuss within our group—with our interventional cardiologists—what the best strategy is to treat the patient. It's usually agreed that coronary artery bypass surgery should be performed in patients with extensive three-vessel disease, particularly those with diabetes.

Peter Zombori: Thank you for that explanation. So, let's go back to the intervention. You take out veins and arteries, right? And then...

Prof. Jürg Grünenfelder: Yes. And then, the veins we use are connected to the aorta; that's why it's called aortocoronary bypass surgery. We connect the vein to the aorta and then to the coronary arteries. This allows oxygenated blood to flow from the aorta through the vein into the coronary artery, providing additional blood flow and oxygen to the heart and arteries. If we use the mammary artery, we leave it attached to its origin inside the chest and just reroute it to the heart. So, we only need to make one connection to the coronary artery if we use, for instance, the left or right mammary artery. We call this "leaving the mammary in situ." But we can also make arrangements to take the right mammary completely out of the chest and connect it to the left. There are many options we can apply to perform all the bypasses we need, but it, of course, always depends on the patient.

Peter Zombori: What's the recovery time for this?

Prof. Jürg Grünenfelder: Since we usually perform these procedures through a median sternotomy—because if we operate, we typically make three, four, five, or six bypasses on all sides of the heart—we usually open up the chest. This means the trauma is a little larger than in patients where we can perform surgery through a small incision. That's why the recovery time is usually a little longer, but again, it depends on the patient. We keep patients for about a week in the hospital after the surgery, and they usually also go to a rehabilitation facility for a rehab program for three weeks. So, they are typically four weeks out of their usual habits.

Peter Zombori: Last question, as in all our heart-related interviews, and as you can see, for the viewers following, we've discussed different topics with Professor Grünenfelder, but something that always comes up is life expectancy after bypass surgery. What are your comments here, please?

Prof. Jürg Grünenfelder: If we have to perform coronary artery bypass surgery, the patient has severe coronary disease, which is typically atherosclerosis—a general disease of the arteries for which we have no cure yet. We can only slow down the progression of the diseased coronary arteries. We perform the surgery because patients actually survive longer with surgery compared to without surgery or compared to stenting. However, it's not that the life expectancy is equal to the normal population after the surgery. But these patients do very well. It depends on the severity of the disease they have, and that's why we cannot say they have an equal life expectancy as the normal population. However, with the surgery, they do much better; they can live a normal life. After surgery and rehabilitation, they feel much better than without the surgery. So, it's a very good operation, which is why we perform coronary artery bypass surgery so often worldwide. It's a very common and very good operation. But, as I said, the life expectancy is not exactly the same as in normal people.

Peter Zombori: Thank you, Professor Grünenfelder. I learned a lot. Much appreciated. Thank you for taking the time.

Prof. Jürg Grünenfelder: You're welcome. Thank you very much.