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Heart Bypass Surgery

  • Definition

    This is an operation in which cardiac surgeons remove part of the blood vessel (graft) from somewhere else in the body, and attach it to a narrowed or blocked coronary artery so the heart muscle ordinarily supplied by that coronary artery can be nourished again.

    It is also known as Coronary Artery Bypass Grafting (CABG, often pronounced "cabbage").


    More than 20 years ago, bypass graft surgery was introduced as a way of treating coronary artery disease. For many people who suffer from unremitting angina, CABG can provide dramatic relief. It is a major operation done under general anesthesia.

    The principle of bypass graft surgery is to construct a new channel so blood can get around the atherosclerotic blockages in the coronary arteries. Therefore, instead of trying to scrape out the plaques, the surgeon uses a segment of a vessel from another part of the body to transport blood to the far side of the obstruction.

    Usually the grafts are fashioned from one of the large, accessible saphenous veins that run down the inside of the leg, although recently there has been a trend toward using the internal mammary arteries located under the chest wall.

    During the operation, your heart will be temporarily stopped, and you will be placed on a heart-lung bypass machine which will oxygenate and warm your blood while the surgeon works on your heart.

    Sewing these grafts into place requires considerable skill. In essence, the surgeon must join two tubes that are only slightly larger than spaghetti. The juncture must be tight enough to keep blood under high pressure from leaking out. But if the stitches are even a fracture of a millimeter off the mark, movement of the blood through the tubes will be compromised. In addition, the tubes must be placed quickly, since complications are more likely the longer the heart is arrested. As intricate as this procedure is, placement of each bypass graft usually takes 15 to 30 minutes, while the entire operation may take 2 to 4 hours. Many patients undergo multi-vessel bypass if more than one coronary artery is narrowed or blocked.

    CABG can be accomplished with a very low mortality rate (1 to 3 percent) in otherwise healthy patients with preserved heart function. However, the mortality rate rises to 4 to 8 percent in older patients and in those who have had a prior CABG.

    More recently, minimally invasive coronary artery surgery techniques (also called limited access coronary artery surgery) are being refined. It's being performed in several medical centers as an alternative to the standard methods for coronary artery bypass graft surgery (CABG). Like CABG, the surgery is done to reroute, or "bypass," blood around coronary arteries clogged by fatty buildups of plaque and improve the supply of blood and oxygen to the heart. The goal is to avoid using the heart-lung machine, and to improve recovery time and complications. Check with your doctor about the success and experience with these procedures in your area, as outcomes can vary by center.

    Another alternative to increase blood flow to the heart is coronary artery stenting. In this procedure, a catheter is placed in the groin and fed into the coronary arteries under direct x-ray vision. A stent, or rigid tube, is placed at the area of blockage to widen the area and prevent it from narrowing again. The catheter is then removed. This is often done as an outpatient procedure.


    How many of my coronary arteries are affected?

    Do you recommend CABG or angioplasty for me?

    What benefits can CABG and angioplasty provide for me?

    What are the risks of surgery?

    What will recovery be like after CABG? After angioplasty?

    Will I need to have another surgery or angioplasty in the future?