Director, Cardiothoracic Surgery
Vice Chair, Surgery
Most Commonly Performed "Open Heart" Procedure
Coronary artery bypass grafting or “CABG” (pronounced “cabbage”) is the most commonly performed “open heart” operation worldwide. Cardiothoracic surgeons perform this procedure to bypass blockages of the coronary arteries of the heart.
The coronary arteries are the blood vessels that supply the heart with oxygen and nutrients. The heart relies on these fuels and oxygen as it works constantly to pump blood through the body. The heart never rests like the other muscles in the body, and it demands a constant supply of fuel day and night. When there are blockages of the arteries to the heart, an individual may experience chest pain or angina pectoris, or ultimately even a heart attack or myocardial infarction. In some cases, particularly in long-term smokers or in individuals with diabetes mellitus, angina may be absent or infarctions “silent.”
The indications for CABG surgery are well established. It has been shown that CABG surgery offers a survival advantage for patients with the critical blockage of left main coronary artery and those with disease of all three major coronary arteries and reduced function of the main pumping chamber of the heart, or the left ventricle. CABG may also be indicated in other specific circumstances, such as in patients with diabetes, previously failed angioplasty / stenting or when a patient is experiencing severe chest pain that cannot be controlled with medicines alone. Coronary artery disease is complex and every patient’s specific situation is different, therefore, you should discuss your circumstances with your doctor.
The traditional technique of CABG involves an incision down the front of the chest through the breastbone (median sternotomy). The standard procedure requires that the patient be connected to the heart lung machine while the bypasses are being performed. Most CABG operations are performed using a combination of bypass grafts including left internal thoracic artery, radial artery of the forearm and saphenous vein of the leg. After the bypasses have been performed the patient is taken off of the machine and their own heart takes over once again.
Newer techniques are currently used at our institution to improve the results and to minimize the discomfort after surgery. The most widely used technique aimed at improving outcomes for the patient is performing the bypass operation without using the heart lung machine. During this procedure, called “off-pump, or beating heart”, the heart continues to do the work of pumping blood to the body while the surgeon conducts the bypass operation. Smaller incisions to perform surgery, known as mid-CAB, or minimally invasive heart surgery, can be done for certain group of patients. These techniques have been shown to decrease the amount of pain and bleeding after surgery and they assure a faster recovery and return to work.
As with any other surgical procedure, there are certain risks that a patient should be aware of prior to surgery. The risk of complications generally depends upon age, general health, smoking history, specific medical conditions, and heart function. Your doctors will only recommend CABG when they believe other options like prescription drugs or balloon angioplasty / stenting cannot achieve the goal of keeping you healthy.
The long term results of CABG are excellent. The majority of patients obtain complete relief of their symptoms of angina after surgery. Some patients notice an increase in their energy level after recovery - and will state that they had not realized how much they had been slowing down prior to surgery. In addition to the relief of symptoms the expected survival, or life-span, for specific subgroups of patients with ischemic heart disease improves after CABG.