Quadruple Bypass Heart Surgery Process and Recovery

Table of Contents
View All
Table of Contents

Quadruple bypass surgery is an open-heart surgical procedure that is done to improve blood flow to the heart muscle. In an open-heart surgery, the chest is cut open and the person is put on a machine to do the work of the heart and lungs during the surgery.

To understand what it means to have a quadruple bypass, it is important to grasp the effects of heart disease and how the disease relates to the structure of the heart. This will help you to understand when bypass surgery may be needed and what it achieves.

This article explains the goals of this procedure and walks you through the steps leading up to it. It also describes what to expect during recovery and some common lifestyle changes after surgery.

What is quadruple bypass heart surgery?
Verywell / Tim Liedtke

Anatomy of the Heart

The heart's muscle pumps to keep blood moving throughout the body.

The heart, like every tissue of the human body, needs oxygen and nutrients so it can do its work. The coronary arteries are blood vessels that supply the heart muscle with blood. Sometimes these blood vessels can become blocked.

A quadruple bypass heart surgery is performed when four blood vessels that feed the heart are blocked. The surgery is needed to reroute blood around the blockages with vessels taken from other parts of the body. Each of these replaced vessels is called a bypass graft.

Purpose of Quadruple Bypass

The coronary arteries can become blocked when plaque builds up inside the blood vessels. This condition is known as coronary artery disease.

If the blockage in the coronary artery is severe, it can interfere with blood flow to a section of the heart muscle and cause chest pain, also known as angina. It is possible to have several arteries blocked at the same time, which can pose a significant risk to the heart.

Usually, the chest pain occurs during physical exertion. This is because the demand for oxygen in the heart is greater. The narrowed vessels are not able to meet the increase in the heart muscle's needs. That is when the chest pain will begin.

If the blockage severely or completely prevents blood from flowing to a part of the heart muscle, a heart attack may occur.

In many cases, coronary artery disease can be treated with medication or lifestyle changes. It also may be treated with surgery that is less invasive than a quadruple bypass, such as angioplasty. A stent, a tube that holds the artery open to restore blood flow, may be placed in the artery.

In general, if one or two vessels need to be repaired, or if the blockage is too long to place a stent, then surgery is likely to be recommended. At the time of bypass surgery, all of the blocked vessels will usually be treated at the same time.

Potential Risks

Bypass surgery can have more risks than less invasive procedures, such as:

  • The risks of general anesthesia, including nausea and vomiting, disorientation, itching, and chills. Serious but rare complications include dangerously low blood pressure, vocal cord injury, and heart attack.
  • The risks of open-heart surgery, including irregular heartbeat (arrhythmia), bleeding, blood clots, organ damage, infection, memory loss, pneumonia, death

For these reasons, bypass surgery is usually only considered when coronary artery disease is severe or has not improved with other types of treatment.

Bypass surgery is a complicated procedure. The risks increase with each additional bypass graft that's needed. For example, double bypass surgery is less risky than a triple, and a triple is less risky than a quadruple bypass.

The procedure takes longer and requires more time under anesthesia for each additional bypass. It's also important to consider that it's being done to treat a severe disease state, and a person's underlying health also increases the risk of surgery.

Success Rate

Coronary artery bypass surgery has a high success rate. About half a million bypass surgeries are performed each year, and approximately 98% of them are completed successfully.

Coronary Artery Disease Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Old Man

What to Expect on the Day of Surgery

General anesthesia is started right before the surgical procedure. Then the cardiothoracic surgeon starts harvesting (removing) veins from the legs or arms. These vessels are used for bypass grafts.

The surgical team will confirm that the vessels are healthy enough to be used to bypass the diseased coronary arteries. Meanwhile, the surgeon opens the chest and begins preparing the heart. They may also remove another vessel from the left chest, to supplement the other veins already harvested.

During the vast majority of quadruple bypass surgeries, the heart is stopped to prevent motion. A heart-lung bypass machine is used to allow both the heart and lungs to be still.

This helps the surgical team complete the graft portion of the surgery safely and quickly. The machine supplies oxygen to the blood instead of the lungs doing so. It pumps the oxygenated blood through the body as the heart would normally do.

During surgery, the blood vessels are attached to the existing heart vessel, around the areas of blockage. It's similar to a quick detour you might take to avoid traffic, with the blood literally rerouted around the blocked portion of the cardiac artery.

How Long Does a Quadruple Bypass Take?

Coronary artery bypass surgery usually takes four to six hours from start to finish. A quadruple bypass may take closer to six hours, given that the operation requires the surgeon to perform multiple bypasses.

What's the Recovery Process Like?

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. There, you will wake up slowly from anesthesia. Unlike other types of surgery, you won't be given any medication to wake back up quickly. Instead, you would sleep off the anesthesia.

Open-heart patients typically spend three or more days in the hospital prior to being discharged. Some people will require cardiac rehabilitation, a structured and monitored exercise program that is designed to strengthen the heart.

The typical recovery lasts between six and 12 weeks. Most people are able to return to their usual activities after recovery is complete.

After surgery, some patients whose activities were limited due to chest pain or fatigue caused by heart disease may find they can do more. For example, many people who reported chest pain with simple activities, such as walking, will no longer have these symptoms.

This does not mean that it is OK to rush into physical activity after surgery. But some people are able to be more active after recovery. The major benefits will become more clear toward the end of the recovery phase when the pain from the surgery itself goes away.

After surgery, it's important to work on lifestyle changes that will keep the new grafts open and working well. These changes may include a heart-healthy diet, with limits on saturated fat and cholesterol.

Exercise also will help. A gradual increase in activity, as directed by your healthcare providers, will help to prevent coronary artery disease from returning.

What Is the Survival Rate of a Quadruple Bypass Surgery?

While the term "open heart surgery" may sound intimidating, coronary artery bypass surgery itself is a relatively simple procedure done routinely in most major medical centers. This operation consistently prolongs life in people who have severe blockages in one or more coronary arteries.

Actual survival rates vary from hospital to hospital along with other factors like a patient's age and sex. But, according to one study, the survival rate following bypass surgery is about 92% after one year, and 83% after five years.

Another study of more than one million people found that following bypass surgery, the risk of death and serious complications was significantly higher in women compared to men.

Summary

A quadruple bypass heart surgery may be necessary if coronary artery disease has caused plaque to build up in the blood vessels and blocked blood flow to the heart. These blockages need to be "bypassed" so the blood flow is rerouted past them.

Your surgeon will take other blood vessels from your body, usually in the legs or arms, and use them to do the bypass. This means they are grafted onto the existing arteries that feed the heart muscle. Once the surgery is complete, blood flow should be restored as it moves around the blockages.

The surgery has its risks, so it is done only when the benefits outweigh those risks. People who have the procedure usually stay in the hospital for a few days. Recovery may take up to 12 weeks.

17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Johns Hopkins Medicine. Coronary artery bypass graft surgery.

  2. Goodwill AG, Dick GM, Kiel AM, Tune JD. Regulation of coronary blood flowCompr Physiol. 2017;7(2):321–382. doi:10.1002/cphy.c160016

  3. Centers for Disease Control and Prevention. Coronary artery disease.

  4. Agewall S. New guidelines for angina pectoris. Tidsskr Nor Laegeforen. 2014;134(5):510. doi:10.4045/tidsskr.13.1552

  5. Johns Hopkins Medicine. Angioplasty and stent placement for the heart.

  6. YaleMedicine. General anesthesia.

  7. National Heart, Lung, and Blood Institute. Heart surgery risks.

  8. University of Utah. Coronary artery bypass surgery (CABG).

  9. Columbia Heart Surgery. Coronary artery bypass grafting (CABG).

  10. Mount Sinai. Heart bypass surgery.

  11. Azarfarin R, Ashouri N, Totonchi Z, Bakhshandeh H, Yaghoubi A. Factors influencing prolonged ICU stay after open heart surgeryRes Cardiovasc Med. 2014;3(4):e20159. doi:10.5812/cardiovascmed.20159

  12. Osailan A, Abdelbasset W. Exercise-based cardiac rehabilitation for postcoronary artery bypass grafting and its effect on hemodynamic responses and functional capacity evaluated using the Incremental Shuttle Walking Test: A retrospective pilot analysis. J Saudi Heart Assoc. 2020 Apr;32(1):25-33. doi:10.37616/2212-5043.1005

  13. National Heart, Lung, and Blood Institute. Coronary artery bypass grafting recovery from surgery.

  14. Mount Sinai. Heart bypass surgery - discharge.

  15. Coyan GN, Reeder KM, Vacek JL, Coyan GN, Reeder KM, Vacek JL. Diet and exercise interventions following coronary artery bypass graft surgery: a review and call to actionPhys Sportsmed. 2014;42(2):119–129. doi:10.3810/psm.2014.05.2064

  16. Hosein Soltani M, Rasti M, Mahdieh Namayandeh S, Sarebanhassanabadi M. Short and long-term outcomes of patients with coronary artery bypass surgery. ARYA Atheroscler. 2021 Sep;17(5):1-6. doi:10.22122/arya.v17i0.2010

  17. Gaudino M, Chadow D, Rahouma M. Operative outcomes of women undergoing coronary artery bypass surgery in the US, 2011 to 2020. JAMA Surg. 2023 Mar;158(5):494-502. doi:10.1001/jamasurg.2022.8156

Additional Reading

By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.