By Kathleen Gaines, MSN, RN, CBC 

Updated on August 16, 2023

 Medically reviewed by Jennifer Schwartz, MD

 Fact checked by Nick Blackmer

You may need triple bypass surgery, a type of coronary artery bypass grafting (CABG), if you have coronary artery disease (CAD) or another condition that impacts circulation to your heart.

Triple bypass surgery does not cure or prevent CAD, but it can prevent CAD symptoms such as chest pain and shortness of breath. Furthermore, it can improve overall heart function and quality of life and reduce the risk of death.

This article outlines reasons for triple bypass surgery, who may benefit from the procedure, and how you can prepare.

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What is Bypass Surgery?

Bypass surgery is a procedure in which blood vessels are taken from other areas of your body to replace diseased areas of your coronary arteries and improve blood flow. These blood vessels can be taken from your leg (saphenous vein), inside your chest (internal mammary artery), or your arm (radial artery). Your surgeon will choose which blood vessel to use as both veins and arteries can be used.

Bypass surgery is not always the first line of treatment for CAD. These alternative treatments may include coronary angioplasty (consisting of stent placement) or the use of medications (like statins). Bypass surgery is often only done when these alternative treatments may not have worked or may not have been possible based on a person's anatomy.

Reasons for Triple Bypass Surgery

The most common reason for triple bypass surgery is CAD due to atherosclerosis. Atherosclerosis, also known as “hardening of the arteries,” occurs when cholesterol and other lipids begin to accumulate on the inner walls of damaged blood vessels. This buildup leads to the formation of a waxy thickening in the vessel, known as a plaque.

Atherosclerosis can develop in any blood vessel in the body, and when it affects arteries in the heart, it can lead to a heart attack.

Chest pain may be a symptom of atherosclerosis. This pain, known as angina pectoris, is due to diminished blood flow in the coronary arteries. It indicates you may need a cardiac revascularization, specifically a cardiac bypass. Whether you need a single, double, or triple bypass depends on the anatomy of your disease.¹

Benefits of Triple Bypass Surgery

Bypass surgery can restore healthy function of the heart. The benefits of surgery include:²

• Managing blockage of blood flow to the heart muscles

• Improving the supply of blood and oxygen to the heart muscles

• Reducing the risk of heart attack

• Improving the ability to maintain physical activity that has been limited by angina or ischemia (insufficient blood supply)

How Common Is Bypass Surgery?

Bypass surgery is the most common cardiothoracic surgical procedure with about 340,000 surgeries performed annually in the United States.³

Who Needs Triple Bypass Surgery?

Guidelines for bypass surgery were updated in 2021. According to these recommendations, bypass surgery may be considered for those who have triple-vessel CAD.¹

You may also be a candidate for bypass surgery under the following conditions:

• Blood flow through your left ventricle is only at 35% or less

• The left main artery is very narrow

• You have diabetes and two or more of the larger arteries are narrow

• Angina persists despite medication

• The benefits of surgery outweigh the risks

Emergency Bypass Surgery

In some instances, you may need emergency bypass surgery. These include very specific situations that occur when you're at risk of a heart attack or following a heart attack.

1) Cases of acute myocardial infarction (heart attack) with the following conditions:

• Stents have not helped or could not be placed

• Blood flow to major areas of the heart is persistently blocked

• Blood pressure is unstable (hemodynamic instability) and cannot be controlled without surgery¹

2) Instances in which a person needs surgery after a heart attack for complications such as:

• Ventricular septal rupture, which causes a tear in the heart muscle

• Mitral valve regurgitation in which the valve that separates the left atrium and left ventricle doesn't close properly¹

3) Cases in which a person experiences cardiogenic shock, which means the heart cannot pump enough blood and oxygen through the body⁴

Preparing for Triple Bypass Surgery

Prior to having triple bypass surgery, you can expect to have a series of tests and procedures to determine if this type of surgery is the best option for you.

Depending on the severity of the heart disease or pain, you may have one or more tests, including:

• Echocardiogram: This test uses an ultrasound to create a picture of the heart while it is moving and to assess the blood flow in and out of the heart.

• Electrocardiogram (ECG or EKG): This study measures the electrical activity of the heart.

• Cardiac catheterization: This is an invasive test that examines specific blockages of the coronary blood vessels using dye and special X-rays to show the insides of the coronary arteries.

• Blood work: These labs may include complete blood count, chemistry, and coagulation studies.

• Chest X-ray: This will look at the chest, lungs, heart, large arteries, ribs, and diaphragm.

• Cardiac magnetic resonance imaging (MRI): This provides a detailed picture of the heart, including chambers and surrounding blood vessels

• Carotid ultrasound: The purpose of a carotid ultrasound is to screen for blockage or narrowing of the carotid arteries, which may increase the risk of having a stroke.

• Transesophageal echocardiogram (TEE): This is an invasive test that looks at the heart valves and chambers and how the heart is functioning.

• Computed tomography scan (CT): This test assesses the structure of the aorta, lungs, and surrounding organs.⁵

If you show signs of needing an emergency triple bypass, your doctor will not waste time ordering time-consuming tests, such as a stress test.

Summary

Triple bypass surgery is a type of heart surgery in which three blood vessels from elsewhere in the body are used to replace damaged vessels in the heart. The purpose of the procedure is to improve blood flow.

A triple bypass is usually recommended only when other less invasive treatments have not improved blood flow. Atherosclerosis is the most common reason for this type of surgery, but a number of serious heart complications can also make it necessary to undergo an emergency bypass.

Your doctor may use a number of tests to determine whether or not this surgery is right for you.