Bypass surgery is a major operation that usually lasts between two and six hours. Pre-operative medications are often administered by mouth, muscular or subcutaneous injection, or IV. You will receive general anesthesia and be completely asleep. During bypass surgery, the chest bone is separated, and the ribs are spread apart to allow visible and physical access to the heart. In most instances, blood circulation and breathing functions will be taken over by a heart-lung machine. The cardiac surgeon uses a piece of vein or artery to form a bypass to enable blood to go around the blockage. Several blockages can be bypassed during surgery. Grafts: A graft is a blood vessel that has been created to bypass a blocked artery . It is usually taken from the internal mammary artery in the chest, the saphenous veins from the leg, or in rare instances from the radial artery in the arm. The graft is attached above and below the area in the artery where there is a blockage, so that the blood can use the new, unblocked path to flow freely to the heart. From stress tests, angiograms and intravascular ultrasounds, your doctor is able to determine exactly how much of the heart structure needs repair. Some patients undergo double, triple or even quadruple bypasses, based on their specific needs. Doctors have found that grafts are most successful when attached to major coronary arteries rather than smaller arterial branches. Doctors have also found better results for bypass surgery when there are discrete, localized blockages rather than a buildup of plaque throughout an artery. In some cases, your blood circulation and breathing functions will be carried out by a heart-lung machine during surgery, also known as cardiopulmonary bypass. However, more coronary artery bypass surgeries are being done while the heart is still beating (called the off-pump technique). Doctors say the beating heart approach reduces the risk of neurologic injury, stroke and other complications associated with the heart-lung machine, and leads to a shorter hospital stay for patients. As with any serious heart surgery, blood transfusions are necessary during bypass surgery. The blood used for your surgery will be matched by type and Rh factor, and provided by a local blood bank. Unless your surgery is scheduled to be performed in less than 72 hours, and if your doctor gives you permission, arrangements can be made for banking your own blood for surgery. You also may have family or friends with a compatible blood type donate blood for your surgery. The hospital, the Red Cross or blood bank can provide family members and friends with necessary information about blood donation for your surgery. A close family member had a quadruple by-pass,and was home in a week. He made a full recovery.