Coronary Artery Bypass Graft Surgery (CABG)

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By Caralee Adams
Illustrations by Echo Medical Media

Thousands of coronary artery bypass surgeries are performed each year to improve blood flow to the heart. Here’s what you should know about this important procedure.

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Coronary artery bypass graft surgery is not something to be taken lightly. It is a major operation that usually involves cutting the breastbone in half and temporarily stopping the heart. Then arteries or veins from the leg, chest, or arm are sewn directly to arteries feeding the heart muscle to bypass upstream blockages that impair blood flow.

Why go through all of this? “It’s a durable operation,” says Ashish Shah, M.D., a cardiac surgeon and assistant professor at The Johns Hopkins University School of Medicine and its Heart Institute in Baltimore. “This operation seems to help people live longer and stay out of the hospital because of cardiac-related problems for 10 to 20 years.”

Bypass surgery has a high success rate and reduces the chance of heart attack, and patients feel significantly better soon afterward.
 
Who should have coronary bypass surgery?
Bypass surgery is recommended for patients who have multiple, severe blockages of their coronary arteries. When this happens, the heart is deprived of oxygen and nutrients, which can cause chest pain. Surgery is needed when heart muscle damage is so severe that it impairs heart function and blockages can’t be treated by other means, such as angioplasty.

What are the different types of bypass surgery?
On-pump: After an incision is made in the chest, the surgeon saws through the breastbone and opens the rib cage to expose the heart. The heart is temporarily stopped and a heart-lung machine takes over. One end of a healthy blood vessel—or graft—is attached just above the blocked vein and the other end below. Blood can then flow in a detour around the bad artery. An electrical shock starts the heart pumping again after the graft has been attached. This classic approach is used in about 70 percent of cases.

Off-pump: The same bypass of blockages is accomplished but without stopping the heart or using the heart-lung machine. The area of the heart being worked on is stabilized as the graft is attached. Working on a moving muscle requires a skillful surgeon, says Paul Corso, M.D., section director of Cardiac Surgery at Washington Hospital Center in Washington, D.C. But without the heart-lung machine there are fewer complications, such as stroke, because you don’t have to connect tubes through the heart and dilute blood.

Minimally invasive: A small incision is made and the bypass grafts are made using scopes and, in some cases, robots so the breastbone does not have to be opened. This may be an option if there are just one or two arteries to be bypassed, Corso says. Still, a heart-lung machine is used with this procedure. Just a fraction of patients opt for this technique.