Strong Heart and Vascular Center

Division of Cardiac Surgery

Angioplasty vs. Bypass Surgery For Coronary Artery Disease (CAD) The choice of angioplasty or bypass surgery is based on physician and patient preference, as well as patient-specific diseases, such as diabetes or heart failure, which may favor one procedure over another. More information

Coronary Artery Bypass Grafting (CABG)

We perform coronary artery bypass grafting (CABG or “cabbage”) to bypass blockages or obstructions in the coronary arteries, thereby restoring the flow of oxygen and nutrients to the heart. This process is also known as revascularization.

CABG, an open heart procedure, requires a median sternotomy, or incision down the front of the chest through the breastbone. This incision gives the surgeon a good view of the heart.

Traditionally, the heart is stopped during the CABG process. The patient is kept alive by a heart-lung machine during the operation. This is known as cardiopulmonary bypass.

To perform a CABG, arteries from the chest and arm and veins from the leg are used to create a detour around the obstruction in the coronary artery. The artery and/or vein are connected to both the aorta and coronary artery, thereby creating a bypass around the blockage.

New CABG Techniques

As part of our mission, we’re always researching new ways to perform surgery with less patient discomfort, better heart function, and faster recovery. The procedures are called minimally invasive because they minimize the trauma of surgery. Statistics are showing that these new techniques also reduce the need for repeat operations in the future.

• Endoscopic vein harvesting. A minimally-traumatic procedure where we create a small incision to remove veins from the leg.
  
  
• Multiple arterial grafts. Techniques to increase the utilization of arterial grafts continue to evolve. The use of both internal thoracic ateries and artery from the forearm (radial artery) is frequently used for long-term revascularization in appropriate patients.
  
  
• Off pump surgery. We’re also excited about the ability to perform bypass surgery without using the heart-lung machine. This is known as off pump coronary revascularization. In this surgery, we operate on the beating heart without relying on cardiopulmonary bypass (stopping the heart and using the heart lung machine to pump blood to the organs). As a result, we greatly reduce the risks associated with the heart lung machine, such as blood clots.
  
  
• Smaller incisions. By using smaller incisions, we decrease the chances of infection, lessen pain, speed healing, and minimize scarring. For example, in Port Access Coronary Artery Bypass Surgery, we create small incisions, known as “ports,” in the chest. Then the surgical team uses special instruments to reach through the ports to perform the surgery. The surgery involves taking chest arteries or veins from the leg (femoral vessels) to create a detour, or bypass, around the clogged artery(ies). The surgeon views the operation through video monitors, rather then directly, giving him/her a much improved view of this intricate work.

• Disease of the left main coronary artery or all three major coronary arteries
• Defective left ventricles
• Severe angina (not helped by medication)
• Patients unable to be helped by aggressive medications and balloon angioplasty

• Bleeding
• Infection
• Stroke
• Kidney failure
• Needing repeat surgery (usually after 10 years)

The potential for complications varies, depending upon the patient's overall health, age, smoking history, medical conditions, and heart function. If you are facing cardiac surgery of any type, discuss these risk factors with your doctor to determine the best treatment for you.