Coronary artery disease is caused when plaque build-up narrows or blocks blood vessels in the heart.  One way to treat patients diagnosed with this condition is to perform coronary bypass surgery.

In a Coronary Artery Bypass Graft or CABG (pronounced “cabbage”) procedure, one or more healthy blood vessels will be taken (or harvested) from the leg, arm or chest and will be used to create “new” vessels for the heart. The resulting new blood flow path is called a bypass graft. The bypass graft enables blood to reach your heart by flowing around (bypassing) the blocked portion of the diseased artery. The increased blood flow reduces angina and the risk of a heart attack. CABG can be performed one of two ways:  “On-pump” using a cardiopulmonary bypass machine or “Off-pump”, often referred to as Off-pump Coronary Artery Bypass (OPCAB) where the heart is kept beating during the procedure.

• On-Pump Cardiac Surgery: The majority of open heart cardiac surgery cases are performed using Cardiopulmonary Bypass (CPB), or a heart-lung machine that supports critical physiological functions for the patient’s body while the heart is being operated on. This is especially important during procedures such as coronary artery bypass surgery, heart valve replacement and repair, the repair of congenital heart defects, and certain vascular procedures.
• Beating Heart Surgery: A type of procedure that does not stop the heart and is done without putting the patient on a heart-lung machine.
• Endoscopic Vessel Harvesting (EVH): A way to acquire a healthy blood vessel used for the bypass graft with a much smaller incision.

The heart’s job is to keep blood circulating in and out of your lungs and through all the other organs and tissues in your body. Like any muscle, the heart needs plenty of oxygen-rich blood to stay healthy and keep functioning. The blood vessels that surround the heart are called the coronary arteries. When fatty deposits called plaque develop in the lining of these arteries several things can happen:

• The lining of the artery becomes thicker and rougher.
• Plaque buildup makes it harder for blood to flow through the artery.
• The heart has to work harder to pump blood.
• The plaque may rupture, causing a blood clot that can completely block the artery; this stops the supply of blood to the heart muscle.
   

If one or more arteries become blocked, the results can range from mild chest pain (angina) to severe heart attack. Coronary artery bypass graft surgery relieves chest pain and ischemia, improves a patient's quality of life, and in some cases, prolongs a patient's life expectancy. The goals of the procedure are to enable a patient to resume a normal lifestyle and to lower the risk of a heart attack.

When a patient is diagnosed with coronary artery disease, a surgeon can perform an operation to restore healthy blood flow to the heart. In this procedure, one or more healthy blood vessels will be taken from the arm, leg, or chest and are used to create “new” vessels for the heart. The surgeon will connect or graft one end of the harvested vessel to the aorta that supplies the blood to the heart; the other end will be attached at the surface of the heart, bypassing the blocked portion of the coronary artery. It is not uncommon for a surgeon to perform three or four of these grafts during one operation.

Your hospital stay will range in length from three to seven days, depending on the type of procedure performed and any treatments that are necessary afterwards.

Talk to your doctor about the specific procedure he or she will be performing and what to expect once the procedure is completed.

When a patient is diagnosed with coronary artery disease, a surgeon can perform an operation to restore healthy blood flow to the heart. In this procedure, one or more healthy blood vessels will be taken from the arm, leg, or chest and are used to create “new” vessels for the heart. The surgeon will connect or graft one end of the harvested vessel to the aorta that supplies the blood to the heart; the other end will be attached at the surface of the heart, bypassing the blocked portion of the coronary artery. It is not uncommon for a surgeon to perform three or four of these grafts during one operation.

During the operation, the patient is connected to a heart-lung machine, also called a cardiopulmonary bypass pump, which takes over the roles of the heart and lungs during the procedure and cools the body to reduce its need for oxygen. The heart is stopped while the surgeon attaches the bypass grafts. A cold solution of potassium-enriched saline is injected into the aortic root and the coronary arteries to lower the temperature of the heart, which helps prevent damage to the tissue.

When a patient is diagnosed with coronary artery disease, a surgeon can perform an operation to restore healthy blood flow to the heart. In this procedure, one or more healthy blood vessels will be taken from the arm, leg, or chest and are used to create “new” vessels for the heart. The surgeon will connect or graft one end of the harvested vessel to the aorta that supplies the blood to the heart; the other end will be attached at the surface of the heart, bypassing the blocked portion of the coronary artery. It is not uncommon for a surgeon to perform three or four of these grafts during one operation.

Today many people that have medical conditions such as diabetes, history of stroke, or poor physical health can undergo cardiac surgery with a clampless approach which may lower their risk for developing complications. In contrast to conventional bypass surgery, which stops the heart and puts the patient on a heart-lung machine during the grafting procedure, clampless beating heart bypass surgery uses local stabilization of the heart that allows the surgeon to sew the bypass graft while the heart still beats.

The potential benefits of beating heart surgery may include¹:

• Less trauma to the body, since the heart-lung machine is not used
• Fewer cognitive and neurological effects (for example, a stroke)
• Less risk of problems with memory
• Faster recovery rates
• Shorter hospital stays
• Fewer blood transfusions needed
  ¹  Puskas J, Cheng D, Knight J, et al.  Off-pump versus conventional coronary artery bypass grafting.  A meta-analysis and consensus statement from the 2004 ISMICS Consensus Conference.  Innovations.  2005; 1:3-27

During a Coronary Bypass procedure, the surgeon needs to take (or harvest) one or more healthy blood vessels the patient’s leg, arm, or chest; these will be used to create “new” vessels during the heart surgery. This requires a separate procedure that is performed immediately before the heart surgery. One or more of these vessels may be harvested:

• The greater saphenous vein, which runs the length of the leg
• The radial artery, which runs from the wrist to the elbow in the arm
• The internal mammary artery, which is in the chest