The UPMC Heart and Vascular Institute is a leader in innovative techniques for coronary artery bypass graft (CABG) surgery. CABG is one of the most commonly performed surgeries in the United States.
Also known as coronary artery bypass surgery or heart bypass surgery, CABG restores blood flow to the heart in patients with blocked arteries caused by coronary artery disease. Our cardiac surgeons at UPMC offer multiple options for bypass surgery including traditional open heart surgery, minimally invasive, robotically assisted bypass surgery through a small incision between the ribs (MIDCAB), and robotically assisted total endoscopic bypass (TECAB).
CABG surgery restores proper blood flow to the heart and treats severe blockages that cannot be treated with stents.
During CABG, your surgeon:
There are several methods surgeons use to perform CABG surgery. The surgeons at UPMC will recommend the best option for your specific condition. CABG surgery options include:
During open-heart CABG surgery, your surgeon will open your chest by dividing the breastbone in half and use a blood vessel taken from another part of your body to “bypass” the blocked portion of your artery. This creates a new pathway for blood to flow and around the blockage.
Our surgeons have extensive experience performing traditional open-chest CABG procedures that require a heart-lung bypass machine. While traditional open-chest procedures have a longer recovery time than minimally invasive procedures, they may be the best option for patients with severe coronary artery disease or those who need multiple bypasses.
The surgeons at UPMC also perform CABG surgery using the most advanced, minimally invasive techniques that do not require opening the chest through the sternum. Minimally invasive CABG techniques offer benefits, including:
Minimally invasive CABG techniques include:
"Off-pump" CABG surgery, also known as beating-heart surgery, does not require you to be on a heart-lung bypass machine. During the operation, your surgical team will use specialized technology to stabilize areas of your beating heart.
"Off-pump" surgery is not for everyone, but it may be suitable if you are at high risk of complications from using the heart-lung bypass machine.
To reduce your risk of complications, our surgeons also use the latest minimally invasive techniques to harvest the veins or arteries that are used to bypass your heart blockage.
During a procedure called endoscopic vein harvesting or endoscopic radial artery harvesting, your provider, will use an endoscope (a thin surgical tube with a light and camera on the end) to locate blood vessels that will be used to bypass your blocked coronary arteries. The blood vessels are removed through small incisions.
Traditional (open) approaches involve making long surgical incisions down the inner thigh and/or calf. Research comparing traditional approaches with endoscopic methods shows that patients generally have fewer complications, less leg pain, and shorter hospital stays with the endoscopic harvesting methods.
The most common condition we treat with CABG is coronary artery disease. For people with coronary artery disease, their arteries are narrowed due to plaque buildup in their blood vessels, which prevent blood flow to the heart muscle.
Some symptoms of coronary heart disease include:
Left untreated, coronary artery disease may cause a heart attack.
CABG also helps people who don't have a coronary artery disease diagnosis but may have decreased blood flow to their heart muscle for other reasons.
CABG restores proper blood flow to the heart if your arteries become blocked. It can also treat symptoms of coronary artery disease and reduce your risk of having a heart attack.
CABG may be an option for you if:
People who have blocked arteries due to coronary artery disease may be candidates for CABG. However, your doctor will consider other factors before recommending CABG, including:
People who are older, have certain other medical conditions, or are in poor overall health may not be candidates for the CABG procedure.
Other treatments for coronary artery disease that may be an alternative to CABG include:
As with any cardiac surgery, CABG poses risks and complications like:
Your age, other health problems, and the amount of blockage in your arteries also increase the likelihood of complications after surgery.
If you have any concerns, talk to your doctor before having coronary artery bypass surgery.
Once you have been found to have coronary artery disease, typically by cardiac catheterization, your doctor will order more tests to see if bypass surgery is right for you.
Tests may include:
The results will help your doctor learn how severe your heart disease is and how much blockage you have. Your doctor will also consider other factors before recommending CABG, including your age, overall health, family history and personal preferences.
If your doctor clears you for heart bypass surgery, he or she will give you details on how to best prepare.
CABG surgery usually takes 2-6 hours, depending on how many bypass grafts you need.
During your CABG procedure, you will be under general anesthesia and on a ventilator with a breathing tube.
You won’t be awake and will not feel any pain.
Depending on the type of CABG procedure you are having, your surgeon will either open your chest or make small incisions in your chest to gain access to your heart. You may also be connected to a heart-lung bypass machine, which will take over for your heart and lungs during the surgery.
Your surgeon will sew healthy arteries from your chest and/or forearm and veins from the leg onto your blocked arteries, rerouting the blood flow to bypass it. Your procedure will vary depending on:
To create the bypass, your surgeon will:
After your surgeon bypasses your blocked artery, they will close your incision, and you can start to heal. The breastbone takes 6-8 weeks (about 2 months) to heal.You will have activity restrictions to help it heal properly.
When your CABG surgery is complete, you will be moved to recovery. The length of your hospital stay will depend on your specific situation.
Your recovery after CABG surgery depends on the approach your doctor used, your overall health, and other factors. It can take a few months to fully recover, so you should avoid any strenuous activity until your doctor says it’s OK.
Your doctor will let you know when you can return to work or resume other everyday activities. You should be sure to follow your doctor's instructions after your procedure and go to all follow-up appointments.
You might also need to make lifestyle changes and take medicine to prevent future blocks in your arteries.
You will be closely monitored while you are in the hospital after your CABG procedure. After you go home, you should let your doctor know if you experience:
CABG is effective at restoring blood flow to your heart, reducing symptoms of coronary artery disease, and lowering the risk of heart attack. However, your prognosis will depend on several factors that your doctor will discuss with you.
When performed by experienced cardiac surgeons such as the team at UPMC, CABG procedures are successful at restoring blood flow to your heart, reducing symptoms of coronary artery disease, and lowering the risk of heart attack.
However, CABG surgery doesn’t cure the cause of coronary artery disease. To increase the chance of success, it’s important to follow your doctor’s recommendations for ongoing care and lifestyle modifications.
UPMC surgeons have extensive experience performing traditional open-chest CABG procedures that require a heart-lung bypass machine. They also perform CABG surgery using the most advanced, minimally invasive techniques. Our surgeons will consider your age, overall health, cardiac condition, and personal preferences and recommend the best treatment option for you.
Last reviewed by a UPMC medical professional on 2024-10-01.
