Tests & Procedures > Cardiac Surgery > Coronary Bypass Surgery (CABG)

Coronary Bypass Surgery (CABG)

PinnacleHealth CardioVascular Institute is a leader in innovative techniques for Coronary Artery Bypass Graft, now one of the most commonly performed surgeries.

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Heart, Vascular & Lung Care

The technical name for “heart bypass” or “bypass surgery” is Coronary Artery Bypass Graft surgery (CABG). It is often recommended for patients who have a blockage or a significant narrowing of the heart arteries and has become one of the most common surgical procedures performed in this country. In the CABG procedure, a surgeon grafts a healthy artery from the chest (mammary artery) or a vein from the leg (saphenous vein) onto the blocked artery, providing a way to reroute the blood flow and thus bypass the blockage.

Advanced Options for CABG

There are several methods surgeons use to perform bypass surgery. The surgeons at PinnacleHealth CardioVascular Institute (PHCVI) are expert at the most advanced minimally invasive procedures including:
  • "Off Pump" surgery which does not require the patient to be on a heart-lung machine
  • Robotically assisted surgery which allows the surgeon to operate with minimal disruption to areas around the surgical site.
  • Keyhole surgery, using several small incisions rather than an open chest approach.

On-Pump

The traditional method of performing bypass surgery involves use of a heart-lung bypass machine that takes over the function of these organs for the patient during surgery. The heart is stopped for this “on pump” bypass surgery, enabling the surgeon to perform the bypass on a “still” heart.

Off-Pump

PHCVI surgeons commonly perform “off-pump” bypass surgery, also known as “beating heart” surgery. Off-pump surgery requires specialized technology to stabilize areas of the beating heart, enabling the surgeon to operate without using the heart-lung machine. Off-pump surgery is not for every patient, but may be ideal for those at increased risk for complications from the heart-lung machine.

da Vinci® Surgical System

The newest technique for bypass surgery is a minimally invasive approach, robotically assisted with the da Vinci® Surgical System. This state of the art technology provides a way for the surgeon to gain access to a patient’s heart using several small incisions instead of a large chest incision. This approach enables the surgeon to have better visualization and greater precision while performing the procedure. The surgeon operates the robot from a console equipped with sensitive controls. The robotic arms are very agile and work as an extension of the surgeon’s hands.

Endoscopic Vein Harvesting

Two other surgical improvements for persons undergoing CABG are endoscopic vein harvesting and endoscopic radial artery harvesting. In both of these procedures surgeons use an endoscope (thin surgical tube with a light and camera on the end) to locate blood vessels that will be used for bypassing the blocked coronary arteries. Veins are generally harvested from the inner thigh and calf areas of the legs, while the radial artery is harvested from the wrist.

Traditional (open) approaches involve making long surgical incisions down the inner thigh and/or calf. Research comparing traditional approaches with endoscopic methods indicates that patients generally have fewer complications, less leg pain, and shorter hospital stays with the endoscopic harvesting methods. Some persons, however, may not be eligible for these methods because of other health conditions.

The benefits of minimally invasive procedures:

  • Smaller incisions
  • Fewer side effects
  • Fewer complications
  • Less pain
  • A reduced risk of infection
  • A faster recovery

Risks of the procedure

Possible risks associated with coronary artery bypass graft surgery include, but are not limited to, the following:
  • Bleeding during or after the surgery
  • Blood clots that can cause heart attack, stroke, or lung problems
  • Infection at the incision site
  • Pneumonia
  • Breathing problems
  • Cardiac dysrhythmias/arrhythmias (abnormal heart rhythms)

Before the procedure

Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
  • In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
  • You will be asked to fast for eight hours before the procedure, generally after midnight.
  • If you are pregnant or suspect that you are pregnant, you should notify your doctor.
  • Notify your doctor if you are sensitive to or are allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
  • Notify your doctor of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
  • Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop some of these medications prior to the procedure.
  • Your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.
  • Notify your doctor if you have a pacemaker.
  • If you smoke, you should stop smoking as soon as possible prior to the procedure. This may improve your chances for a successful recovery from surgery and benefit your overall health status.
  • Based on your medical condition, your doctor may request other specific preparation.
Coronary artery bypass graft surgery requires a stay in a hospital. Procedure may vary depending on your condition and your doctor's practices.