Coronary heart disease is the number one single cause of death in the United States. Knowing the warning signs of a heart attack are crucial. In this Avera Medical Minute, KSFY got a rare look inside an operating room at the Avera Heart Hospital while a patient under went quadruple bypass surgery.

A word of caution, this might be a little too graphic for some of you to watch.

Cardiovascular Surgeon with the North Central Heart Institute, Dr. Jim Reynolds and his team, which includes another surgeon, 4 nurses, a perfusionist and an anesthesiologist are beginning quadruple coronary bypass surgery.

Dr. Reynolds says, "It's a kink in the gas line so to speak. And we put a bypass around it so the heart has enough blood, in this case, to function appropriately."

The 73 year old man on the table had carotid artery surgery at the Avera Heart Hospital 5 days prior and developed a heaviness in his chest. Dr. Reynolds says he had ignored signs of heart disease. Since the patient was already in the hospital and knew he needed surgery, he decided to just get it done while he was here.

Dr. Reynolds says, "He has too many blockages and too many blockages in areas where stents work poorly. There is a place for bypass and it can provide excellent help for many people."

While Dr. Jim Reynolds is opening up the chest. Dr. Tommy Reynolds is harvesting the vein in the leg.

After the sternum is separated, the pericardium is opened exposing the beating heart. Then work begins on getting the mammary artery. It's standard practice to use the mammary artery along with a vein out of the leg. In this case, they used the artery on the left side and the vein out of the patients right leg.

Dr Reynolds says, "The breast bone artery is attached to the bottom of the bone so what I have to do is separate it down which is tedious work. Finally I have it in view. That's it right there, do you see it?"

Once the vein and artery are harvested, they will stop the heart and perfusionist Tom Kenyon will keep him alive with the heart and lung machine.

Tom says, "It takes over for the patient's heart and lungs during surgery. They stop the heart because the surgeon can't work on a beating heart and the lungs get in the way."

This surgery averages about 4 hours, but it will add years to the patients life.

It takes about 5 to 7 days in the hospital to recover from open heart surgery. After watching the surgery, it's easy to understand why you are so sore afterward. In most cases, Dr. Reynolds says the bypass will last 15 to 20 years sometimes even 25 years and can be a long term fix to a heart that is not working to it's full capacity.