Coronary Artery Bypass Graft (CABG)

A coronary artery bypass graft, often called CABG and pronounced “cabbage,” is commonly known as bypass surgery. The primary goal of the procedure is to improve blood flow to the heart muscle by creating a new pathway for oxygen-rich blood to reach the heart, bypassing a diseased artery. This is typically performed when arterial plaque has created enough of a blockage that the patient’s cardiologist believes that there is a high risk of a heart attack.

Traditional CABG Procedure

During the procedure, an incision is made over the breastbone or sternum and the ribcage is cut and separated to access the heart. Typically, the patient will be connected to a heart-lung machine which temporarily takes over the blood-pumping function during the procedure. This allows the heart to be stopped if needed while the surgeon performs the graft.

One or more healthy thoracic arteries or saphenous veins, sourced from the chest and legs respectively, are grafted to the blocked coronary artery, thus bypassing the blockage and restoring circulation.

After the graft has been sewn in place, the surgeon may attach a pacemaker to normalize the beating of the heart. This is especially important if an external heart pump has been employed. Once the heart is beating normally, the external heart pump will be disconnected and the pacemaker removed. The sternum is wired back into place and the incision is sutured. A drain will be placed temporarily. Typically, the traditional CABG is indicated when three or four arteries are being bypassed.

The entire procedure takes four-to-six hours and is performed under general anesthesia. Recovery time is approximately six-to-eight weeks.

Minimally Invasive CABG Procedure

Improvements in surgical devices and technique now allow for single and double bypasses to be performed in a minimally invasive manner, employing a single, 3-5 inch incision or several smaller incisions in the chest between ribs. This is in contrast to the large, 12-inch incision that separates the sternum in open surgery.

The most significant difference in technique is that the heart never stops beating during the minimally invasive surgery. This, of course, presents a challenge as the transplanted artery needs to be sutured into place. To help facilitate, a special mechanical stabilizer is used to dampen movement in the part of the heart being operated upon.

Minimally invasive surgery offers several benefits including shorter hospital stays, less blood loss, less pain, a lower risk of infection and a generally faster recovery. Patients are typically back to normal activity in two-to-three weeks. Results are similar to those achieved with traditional open CABG.

You and your surgeon will have the opportunity to discuss the options for bypass surgery at a pre-operative consultation. Benefits and risks will be analyzed to understand the best option for you.