Coronary Artery Bypass Grafting (CABG) is the most commonly performed heart procedure in the United States. This heart bypass surgery procedure is performed on patients with significant blockages in their arteries, known as atherosclerosis. If the blockages are significant enough, a patient is at-risk for heart attack and even sudden death. The artery bypass surgery procedure re-routes the blood around the blockages by using veins from the leg and/or an artery from behind the breast bone (known as the internal mammary artery or IMA). In addition, sometimes an artery from the arm, known as the radial artery, may be used for bypass. The procedure takes two to four hours, depending upon the number of "bypasses" required. A physician assistant will remove the vein from the leg while the surgeon opens the chest by dividing the breastbone or sternum to expose the heart. The IMA is taken down and one end is prepared for bypass grafting. For a conventional CABG procedure, tubes are inserted into the heart and major blood vessels so that the patient can be placed on the heart-lung machine; blood is re-directed from the heart into the heart-lung machine, which permits the surgeon to safely operate on the heart without blood pumping through it. The surgeon uses the veins and arteries to bypass the blockages. After heart bypass surgery, the breastbone is rejoined using stainless steel wires and the incision is sewn up.
On Pump versus Off-Pump Surgery
For some patients, our heart surgeons utilize an innovative approach that does not require the use of the heart-lung machine; this operation is called "off-pump coronary artery bypass grafting" or OPCAB. Indications for performing this procedure are more limited, however, there may be advantages associated with the OPCAB in that it eliminates some of the risks associated with using the heart-lung machine. In most patients these risks are quite small but in some patients, with severe atherosclerosis, poor kidney function or significant lung disease, these risks may be more considerable. The procedure itself is similar to the conventional CABG procedure described above other than the fact that the heart-lung machine is not used. Instead, a stabilizing device is placed on the surface of the heart, limiting the motion of the beating heart.