Coronary Artery Bypass Surgery (CABG)

Coronary artery bypass surgery creates a new route for blood to reach the heart. Also called coronary artery bypass grafting (CABG) or heart bypass, it is the most common heart surgery in adults.

Why it is done

The coronary arteries supply the heart with blood. In coronary artery disease, a sticky material called plaque builds up inside them, hardening and narrowing them until parts of the heart do not get enough blood. Bypass surgery treats a fully or partly blocked coronary artery.

Before recommending it, a health care provider may try lifestyle changes, medicines or angioplasty, a procedure to open the arteries. If those do not help, surgery may be next. For people with obstructive coronary artery disease, it can lower the risk of heart attack; the provider will weigh your overall health before deciding. You may benefit if you have:

• coronary heart disease with angina (chest pain);
• diabetes;
• several blocked coronary arteries;
• serious heart failure.

Emergency bypass surgery may also be needed to treat a severe heart attack.

What happens

The surgeon takes healthy blood vessels from another part of the body and attaches them above and below the blocked artery, so that blood can flow around the blockage. People with several blocked arteries may need more than one bypass. The methods are:

• Traditional CABG, the most common: the chest is opened, and a machine pumps blood through the body during the operation.
• Off-pump CABG: the chest is opened, but no pump machine is used.
• Minimally invasive CABG: small incisions in the chest, with no pump machine.
• Robotic-assisted surgery, a minimally invasive method in which the surgeon uses a computer to control instruments on robotic arms; a pump machine may be used.

Risks

Results are often excellent, but like any surgery CABG carries risks, including:

• arrhythmia;
• bleeding;
• heart attack;
• infection;
• kidney failure;
• stroke.

Afterward

Many people stay free of symptoms for years. Surgery may be needed again if the grafted vessels become blocked, or if blockages form in arteries that were clear before. Lifestyle changes and medicines can help keep arteries from clogging again.

Sources

• MedlinePlus, National Library of Medicine: "Coronary Artery Bypass Surgery," drawing on the National Heart, Lung, and Blood Institute.