Are you scared about coronary artery bypass graft surgery? Let's talk about it simply.

Do you sometimes feel chest pain or tightness? Do you find it hard to breathe when you exert yourself? Your doctor may have talked to you about bypass surgery. It's normal to feel a little scared or nervous when you hear the word "bypass." But don't worry. Today, we'll talk about heart bypass surgery, or what's medically called Coronary Artery Bypass Grafting (CABG), in a very simple way that you can understand.

Simply put, what is bypass surgery (CABG)?

Imagine that there is heavy traffic on your way to work every day, or the road is closed. What do you do then? You take a different route, that is, a side road or another road, right? That's what happens with this surgery.

We have the main blood vessels (arteries) that supply blood to our heart. We call these the coronary arteries. Over time, things like cholesterol from the food we eat build up inside these arteries, like rust building up inside a pipe, narrowing the passage. We call this build-up material `(Plaque)` or `(Atheroma)`. When the arteries become narrowed in this way, the heart muscle does not get the amount of blood it needs. That is when chest pain `(Angina)` comes. If this blockage becomes too much, and a blood clot forms and completely blocks the narrowed passage, a `(Heart Attack)` can occur.

So, bypass surgery is about creating a new path, a new vein, for blood to flow to the heart, bypassing that blocked, narrowed blood vessel. It's like creating a new road to bypass that traffic jam. To create this new path, a blood vessel is taken from your own body. Most often, a vein taken from the leg, arm, or inside the chest is used for this.

Sometimes, it's not just one blood vessel that gets blocked. It can also block two, three, or even four vessels. When that happens, new paths have to be made for each of them. We call that a ``double (2),`` ``triple (3),`` or ``quadruple (4) bypass`` surgery.

How do you prepare before surgery?

Since this is a major surgery, you will undergo several tests to check your physical fitness before the procedure. Only after these tests will you be able to handle the surgery and decide if you really need it.

In addition to these tests, your doctor will ask about any medications you are currently taking. Some medications (especially blood thinners) will need to be stopped a few days before surgery. You may also need to stop eating and drinking (fasting) a few hours before surgery.

How is the surgery performed?

This may sound a little scary, but these things are done while you are completely anesthetized, meaning you are in a deep sleep where you don't feel anything.

1. Anesthesia: First, you will be anesthetized and put into a deep sleep. You will not feel anything until the surgery is over.

2. Heart bypass: Often, during surgery, the function of the heart and lungs is temporarily transferred to a special machine called a ``Heart-Lung Bypass Machine''. This is done to continuously supply the body with oxygen and blood. In some cases, this surgery is performed while the heart is still beating. This is called ``Off-pump CABG''.

3. Incision for the operation: The surgeon makes an incision in the middle of the chest, down along the sternum.

4. Opening the chest: Then the breastbone is carefully cut down the middle and then split in two to reach the heart. Don't worry, this will be reattached after the surgery and will heal.

5. Creating the bypass: Next, as discussed earlier, a piece of healthy blood vessel from your leg, arm, or chest is taken, and one end of it is attached to the main artery of the heart, the aorta, and the other end is attached below the blockage. This is how the new path is created.

6. End of the surgery: After the bypass is done, the heart is restarted and disconnected from the machine. The sternum is then reattached with a special wire, and the chest incision is closed with stitches.

The entire procedure can usually take anywhere from three to six hours , depending on how many bypasses you need and your health condition.

Are there different methods of performing the surgery?

Yes, with the advancement of technology, there are now several ways to perform this surgery.

• Off-pump CABG: This does not use the heart-lung machine. The surgeon performs the surgery while the heart is still beating.
• Minimally Invasive CABG: In this, a large incision is not made in the middle of the chest. Instead, several small incisions are made between the ribs and the surgery is performed through them.
• Robot-assisted CABG: In this method, the surgeon performs the surgery using a robot. The incisions are also very small.

Your surgeon and medical team will decide which method is best for you.

What are the benefits and risks of this surgery?

Like any major surgery, there are benefits as well as risks, and it's important to be aware of them.

What happens after surgery? The recovery period...

After surgery, you will first be admitted to the hospital's intensive care unit (ICU) . There, everything from your heart function to your blood pressure will be monitored very closely. Once your condition is stable, usually within a day or two, you will be transferred to a regular ward.

You will usually have to stay in the hospital for about five to seven days , after which you can go home.

After going home...

It usually takes about six weeks to fully recover. During this time, you need to be a little careful.

• Avoid lifting heavy objects: Since it takes time for the breastbone to heal, avoid lifting or pushing heavy objects.
• Driving: Doctors usually advise against driving for 4-6 weeks.
• Rest: Get plenty of rest. But don't stay in bed all day. Start walking around and doing small tasks.
• Wound care: The wounds on your chest and where your veins were removed should be kept clean. The hospital will give you instructions on how to care for them.

Do you want to change your life after surgery?

Absolutely yes! This is the most important part. Bypass surgery is just a repair of your blocked arteries. But the underlying condition that caused the blockage, which is cholesterol buildup, is still in your body. The problem can reoccur in the new arteries or in other arteries.

Therefore, it is essential to adopt a healthy lifestyle after surgery.

• Diet control: Reduce foods high in oil, salt, and sugar. Eat more vegetables, fruits, greens, and foods high in fiber.
• Exercise: Start exercising gradually, as advised by your doctor. Walking daily is very good.
• Quit smoking: If you are a smoker, quit today. Smoking is very harmful to the heart.
• Taking medication correctly: Take the medication prescribed by your doctor (which lowers cholesterol, controls blood pressure, and prevents blood clots) on time, without missing a single day.
• Cardiac Rehab: After you leave the hospital, it's a good idea to attend a program like this. You'll be given guidance on how to exercise and control your diet under medical supervision.

When to seek immediate medical advice

After returning home, if you develop any of the following symptoms, go to the hospital's Emergency Department (ETU) immediately .

• Severe chest pain
• Difficulty breathing
• Dizziness or fainting
• Loss of consciousness
• Feeling like your heart is beating fast
• Fever or chills
• Difficulty speaking, drooping of one side of the face, loss of sensation on one side of the body (these could be signs of a stroke)