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What is a Quintuple Bypass Surgery?

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Updated May 28, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Surgeon using defibrillator to restart the heart after open heart surgery
Thierry Dosogne/Stone/Getty Images
Question: What is a Quintuple Bypass Surgery?
What is a quintuple bypass? I've heard of triple and quadruple bypass surgeries, but a quintuple bypass is new to me.
Answer:

A quintuple bypass is an open heart surgery done to treat severely blocked arteries that feed the heart. The procedure is a complicated one, and to truly understand a quintuple bypass, it is essential to understand the anatomy of the heart and effects of heart disease.

The Coronary Arteries

The coronary arteries are the blood vessels that supply the heart with its own blood supply; these are different than the vessels that supply the blood pumped by the heart. In some people, the coronary arteries become blocked, a condition known as coronary artery disease.

It is possible to have one or more arteries blocked in this manner, which can pose a significant risk to the heart. For example, if two vessels are blocked, the surgery is called a double bypass. If four vessels are blocked, the surgery is referred to as a quadruple bypass. A quintuple bypass, therefore, indicates that all five of the major vessels to the heart are diseased.

Why Are Blocked Coronary Arteries So Serious?

If a blockage is serious enough, it can prevent or minimize blood flow to the part of the heart that is fed by the diseased blood vessel, causing chest pain and muscle damage. When the coronary arteries are completely blocked, the muscle that makes up the heart is starved of oxygen. This oxygen deprivation causes significant pain and the resulting heart damage is referred to as a heart attack.

Treatments For Coronary Artery Disease

In some cases, coronary artery disease can be treated with medication, lifestyle changes such as diet and exercise, and less invasive procedures including the placement of stents. However, for some patients, the blockage(s) are so severe that surgery is necessary to make sure the heart continues to receive adequate blood flow. This surgical procedure is known as coronary artery bypass graft surgery (CABG).

The Quintuple Bypass

The CABG procedure may be performed as an emergency, when the patient comes to the emergency room with significant chest pain and is diagnosed with severe coronary artery blockages. Typically, a cardiac catheterization is performed, then the CABG surgery follows if the surgeon feels that it will be effective.

However, the vast majority of CABG procedures, including the quintuple bypass, are scheduled in advance. This allows time for pre-surgery testing that helps determine how many bypasses are needed, if the patient is healthy enough to tolerate the surgery, and their general state of health.

The procedure is performed under general anesthesia. Once the surgery begins, blood vessels are taken from another area of the body, often the leg, and grafted onto the existing heart vessel before and after the blockage. A quintuple bypass requires more vessels than any other procedure, so multiple sites, including the arm, Left Internal Mammary Artery (LIMA), and other vessels may be used.

Obtaining adequate vessels to use for the grafts can be one of the most challenging aspects of the procedure; if the vessels to the heart are diseased, it is likely that the vessels in other regions of the body are also affected. These vessels are then used to detour blood around the blockage on the way to the heart, with the blood literally being routed around (bypassed) the blocked portion of the vessel.

Once the vessels needed for the grafts are harvested, the chest portion of the surgery begins with a sternotomy, the incision that opens the chest and divides the sternum (breastbone) in half to allow the surgeon access to the heart. The procedure is most often performed "on pump" using a cardiopulmonary bypass machine to temporarily do the work of the heart and lungs, allowing the surgeon to stop the heart and perform surgery without the constant movement of the heart beating.

Sources:

What Is Coronary Artery Bypass Grafting? National Heart Lung and Blood Institute. Accessed June 2012. http://www.nhlbi.nih.gov/health/dci/Diseases/cabg/cabg_whatis.html

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