The Complete Process of Coronary Artery Bypass Surgery in China: 12 Key Steps from Anesthesia to Recovery

I am Klaus, a heart patient from Germany. Three months ago, I was diagnosed with severe coronary atherosclerosis in Berlin, and local doctors recommended coronary artery bypass surgery. Considering the international reputation of cardiovascular surgery in China—particularly at top-tier hospitals in Beijing and Shanghai—I decided to fly to Shanghai and undergo the procedure at a top-tier hospital with international medical accreditation. Below is my firsthand account of the “Complete Process of Heart Bypass Surgery in China.” From preoperative preparation to discharge, these 12 key steps document the efficiency and compassion of the Chinese medical team.

Step 1: Multidisciplinary Team (MDT) Consultation—Precision Assessment, No One-Size-Fits-All Approach

On my first day of admission, Professor Zhang, the lead surgeon, organized a multidisciplinary team (MDT) consultation involving cardiology, anesthesiology, the extracorporeal circulation team, rehabilitation medicine, and nutrition. Unlike Germany's common “surgeon-led” model, China's MDT resembled a “brainstorming session”: nurses displayed my 3D coronary angiography reconstructions on tablets, anesthesiologists meticulously inquired about my propofol (anesthetic) allergy history, and rehabilitation specialists even demonstrated early postoperative breathing exercises on the spot. Professor Zhang concluded: “Your left anterior descending artery is 90% blocked, and your right coronary artery is 70% blocked. We recommend a left internal mammary artery graft combined with a saphenous vein bypass for minimal trauma.” This comprehensive “full-chain rehearsal” gave me complete confidence in the surgical plan—Chinese doctors focus not only on “how to perform the surgery” but also on “how to ensure patient safety throughout the entire process.”

Step 2: Preoperative “Psychological Preparation” — The “Talk Therapy” from Medical Staff Was Warmer Than Expected

The night before surgery, the charge nurse, Xiao Zhou, arrived at the ward with a translation app. Instead of rushing into precautions, she first asked, "Mr. Klaus, do you enjoy listening to music? We can play German light music to help ease your nerves.“ She then used a comic-style booklet to explain, ”You may temporarily lose consciousness after anesthesia, but the monitors will track your vital signs 24/7." She even demonstrated how to protect the incision site when coughing post-surgery. What surprised me most was the anesthesiologist proactively explaining in English with gestures: “We'll leave you with a ‘pain pump.’ If you feel pain after surgery, just press the button for medication—no need to endure it.” This approach of treating patients like family felt far warmer than simply signing an informed consent form.

Step 3: Anesthesia Induction—Attention to Detail Before “Drifting Off”

At 6 a.m. on surgery day, I was wheeled into the anesthesia prep room. Nurses secured an “anti-slip restraint strap” around my wrist (to prevent unconscious movement under anesthesia) while attaching a heating pad to my ankle—I later learned hypothermia increases surgical risks, so Chinese doctors proactively maintain patients' core temperature above 36.5°C using warming blankets and fluid warmers. While adjusting the oxygen concentration in my mask, Chief Anesthesiologist Wang said in German, “Take a deep breath, count to ten, and we'll ‘fly’ together.” After inhaling sevoflurane, I quickly slipped into sleep, yet vaguely recalled: nurses placing an arterial catheter under my collarbone (to monitor blood pressure), inserting a central venous catheter into my neck (for IV fluids), and attaching cerebral oxygen monitoring electrodes behind my ears... Every procedure was executed with precision akin to “calibrating precision instruments.”

Step 4: Thoracotomy—Balancing “Minimally Invasive” and “Traditional” Techniques

Entering the operating room, lead surgeon Professor Zhang stood beside the table and confirmed: “Patient's vital signs stable. Begin sterilization and draping.” Unlike traditional open-chest surgery, Chinese doctors favor “minimally invasive median sternotomy”. Instead of a 20cm sternal incision, a specialized retractor now spreads the sternum just 10cm, minimizing disruption to its blood supply. As the electrosurgical knife incised the skin, I detected a faint, acrid scent (later identified as the odor of sterile electrocoagulation for hemostasis), which was quickly drowned out by the rhythmic hum of the anesthesia machine. At this moment, the circulating nurse handed over sterile instruments with movements as swift and precise as “a dance rehearsed a thousand times”—the coordination efficiency in operating rooms of China's top-tier hospitals is truly remarkable.

Step 5: Obtaining the Vascular Graft—The Surgical Art of “Turning Waste into Treasure”

The core of bypass surgery is the “vascular graft”: a healthy segment of blood vessel must be harvested from the patient's own body to bypass the narrowed coronary artery, connecting the aorta to the ischemic heart muscle. Chinese surgeons typically prioritize the “left internal mammary artery” (located alongside the sternum, structurally similar to coronary arteries with high long-term patency rates) and the “great saphenous vein” (a superficial leg vein that is easily accessible). My lead surgeon opted for a “left internal mammary artery + bilateral great saphenous veins” combination: He meticulously dissected the internal mammary artery with precision scissors, preserving surrounding tissues like “peeling an artwork” to avoid damaging the vascular endothelium. Subsequently, he made an incision on the inner calf, segmentally harvested the great saphenous veins, and immediately flushed them with heparin saline to prevent spasm. The entire process took approximately 40 minutes with no unnecessary movements—a testament to the experience gained from performing thousands of similar surgeries annually.

Step 6: Establishing Cardiopulmonary Bypass (CPB)—The Safety Net of the “Artificial Heart-Lung Machine”

To temporarily stop the heart (facilitating precise anastomosis), cardiopulmonary bypass must be established: venous blood is diverted, oxygenated through an oxygenator, and pumped back into the arteries. China's CPB equipment primarily consists of domestically produced high-end models (such as “Sino-Sharp” and “Maicowei”), equipped with real-time monitoring systems capable of precisely regulating blood flow, temperature, and oxygen concentration. After the anesthesiologist adjusted the anticoagulant (heparin) dosage, the perfusionist initiated CPB. The aortic clamp beneath my sternum was applied, gradually stopping my heartbeat. At this point, the operating room temperature drops to 20°C (reducing metabolic demand), but my body is wrapped in a warming blanket. The “Brain Oxygen Saturation 98%” reading on the monitor reassures me—Chinese doctors' emphasis on “organ protection” far exceeds my expectations.

Step 7: Vascular Anastomosis—A Millimeter-Level Precision Challenge

After cardiac arrest, the surgery entered the most critical “anastomosis phase.” Under a microscope or magnifying glass, the lead surgeon used non-damaging sutures finer than a human hair (8-0 or 9-0 polypropylene thread) to anastomose the vessels: First, the distal end of the internal mammary artery was sutured to the distal narrowed segment of the left anterior descending artery (end-to-side anastomosis), with stitch spacing meticulously controlled at approximately 1mm. Next, a saphenous vein graft was used to connect the ascending aorta (proximal) to another narrowed coronary artery (distal). Professor Zhang instructed his assistant during the procedure: “Mind the angle of the vein graft to avoid kinking; tie knots gently to prevent crushing the lumen.” The entire anastomosis took about two hours, each step as delicate as “embroidering on tofu”—the Chinese surgeon's extreme attention to detail left even this “outsider” holding my breath.

Step 8: Restoring Circulation—The Critical 3 Minutes to “Restart” the Heart

After completing the anastomosis, the lead surgeon gradually released the occlusion clamps, allowing blood to flow back into the coronary artery. At this moment, the heart began to “awaken”: first, faint tremors appeared, and the electrocardiogram on the monitor gradually returned to sinus rhythm; then, with the assistance of electrical defibrillation (10J energy), the heart began to beat strongly. The extracorporeal circulation gradually reduces flow until it stops completely—a process known as “circulatory arrest,” one of the most tense moments for Chinese surgeons. Professor Zhang stares at the transesophageal echocardiography (TEE) screen, confirming “normal left ventricular systolic function and no stenosis at the anastomosis site,” before declaring: “Circulation is stable. Extracorporeal circulation can be removed.” A quiet cheer filled the operating room—the team's efforts had finally brought the heart back to life.

Step 9: Chest Closure and Drainage—Patience in “Repair” Outweighs That in “Destruction”

After the heart resumed autonomous beating, the surgery entered its “final phase”: Doctors secured the sternum with steel wires (similar to “reinforcing bars”) and meticulously sutured the subcutaneous tissue and skin layer by layer. Simultaneously, 2-3 drainage tubes (approximately 1 cm in diameter) were placed within the chest cavity to evacuate postoperative blood and fluid accumulation. Chinese surgeons prefer using absorbable sutures for subcutaneous tissue to minimize post-operative discomfort from stitch removal. For skin closure, medical adhesive replaces traditional sutures, offering a more aesthetic result while reducing infection risk. The circulating nurse meticulously inspects each suture point, confirming no bleeding before covering with sterile dressings. By this point, the surgery had lasted six hours, yet it felt “like waking from a long dream.”

Step 10: ICU Monitoring—The “24/7” Guardian of Life

Two hours after surgery, I was transferred to the ICU. The setup here was astonishing: each bedside had a monitor (tracking heart rate, blood pressure, oxygen saturation, and urine output), a ventilator, an infusion pump, and even a portable ultrasound machine (for immediate cardiac function assessment). Nurses recorded vital signs every 15 minutes and assisted me in turning and back percussion every two hours (to prevent pulmonary infections). What moved me most was Professor Zhang's visit to the ICU immediately after surgery. Speaking in German, he reassured me: “The bypass vessels are functioning perfectly. We can remove the endotracheal tube tomorrow.” Additionally, rehabilitation therapists came daily to guide “bedside ankle pump exercises” (preventing lower limb thrombosis), while nutritionists tailored a “low-sodium, high-protein” diet based on my weight. China's hospitals truly achieve “seamless continuity” through their comprehensive postoperative management.

Step 11: Early Rehabilitation—“Getting Moving” Is the First Step

On the third day post-surgery, my tracheal tube was successfully removed, and I was transferred from the ICU to a general ward. That same day, the rehabilitation team devised a “stepwise rehabilitation plan”: Day 1—sitting at the bedside (5 minutes), Day 2: Standing (supported by bed rail), Day 3: Slow indoor walking (50 meters), Day 4: Corridor walking (200 meters). During each session, the therapist would shout in German: “Klaus, push through one more step!” while monitoring my heart rate (not exceeding 20% above resting rate) and blood pressure (systolic not below 90 mmHg). Even more surprising was the consultation with a TCM physician, who taught me “ear seed therapy” to alleviate anxiety (applying Wangbuluxing seeds to the “Heart” and ‘Shenmen’ points on the auricle) and prescribed a “blood-activating and stasis-resolving” herbal decoction (confirmed safe by Western medical evaluation). This integrated “combination of Chinese and Western medicine” rehabilitation model accelerated my recovery.

Step 12: Discharge and Follow-up—A Lifetime Commitment to Health

On the seventh day post-surgery, I met the criteria for discharge. Before discharge, the nurse provided me with a bilingual (Chinese-English) “Post-Coronary Bypass Surgery Rehabilitation Handbook.” It included medication guidance (dual antiplatelet therapy with aspirin + clopidogrel), dietary recommendations (daily salt intake <5g), an exercise prescription (150 minutes of moderate-intensity aerobic exercise weekly), and an “Emergency Contact Card” (marked with the cardiology department's 24-hour on-call number). Professor Zhang, the lead surgeon, specifically instructed: “Return to the hospital for a coronary CT follow-up in three months. We will monitor the patency of the bypass vessels.” What surprised me even more was the hospital's creation of a “Postoperative Follow-up Group” on WeChat. Nurses reminded me daily to monitor my blood pressure and record urine output, with the option to tag doctors anytime for questions. This integrated “online + offline” lifelong management model completely shattered the traditional notion that “surgery ends = treatment ends.”

Conclusion: The “Hardcore” Expertise and “Human Touch” of China's Heart Bypass Surgery

As a foreign patient, my deepest impression is this: China's cardiac surgery not only excels in technical prowess (from minimally invasive techniques to extracorporeal circulation, all reaching internationally leading standards), but also embodies a “patient-centered” philosophy throughout the entire process. From the precise preoperative assessment by multidisciplinary teams to the integration of traditional Chinese medicine in postoperative rehabilitation, from meticulous control in the operating room to lifelong follow-up after discharge, every step reflects the perfect blend of ‘professionalism’ and “humanity.”

Now back in Germany, I've resumed my normal life. At each follow-up appointment, my German doctors marvel at my recovery speed. I believe this is perhaps the “secret weapon” of Chinese healthcare: safeguarding lives with cutting-edge technology while healing hearts with the warmest care.

(Note: The medical procedures described follow current standards at China's top-tier hospitals. Specific practices may vary slightly depending on the hospital or patient's circumstances.)

Document dated 2025-10-15 10:58 Modify