Coronary Artery Bypass Graft (CABG) Surgery

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).

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What Is CABG?

Plaque buildup can cause blockages in the coronary arteries that feed the heart. This causes decreased flow of blood and oxygen to the heart muscle. Over time, this can lead to damage of the heart muscle and weaken the heart.

CABG surgery restores proper blood flow to the heart and treats severe blockages that cannot be treated with stents.

During CABG, your surgeon:

• Takes a healthy vessel from a different part of your body. This is typically an artery from your forearm or chest wall or vein from your leg.
• Sews the healthy vessel to the blocked artery to provide a new path for blood to flow.
• Helps the blood bypass or detour the blockage, restoring the flow of blood and oxygen to the heart muscle.

_{Coronary artery bypass graft is a surgical procedure in which a healthy vein or artery is taken from your leg or arm and used to create a new path for blood flow to your heart. These new paths bypass the blockage and restore proper blood flow to your heart.}

Types of CABG

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:

• Traditional Open-Heart Bypass Surgery —This procedure involves opening access to the heart through the breastbone (sternotomy).
• Robotically Assisted Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) — For this procedure, a small incision is made between the ribs (thoracotomy) .
• Robotically Assisted Total Endoscopic (TECAB) — For this procedure, several small incisions are made for the robotic instruments to enter the chest.

Open-heart CABG surgery

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.

Minimally invasive CABG

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:

• A faster recovery .
• Fewer postoperative restrictions.
• Less pain.
• Less scarring.
• Reduced risk of infection.
• Smaller incisions.

Minimally invasive CABG techniques include:

• Robotically assisted Total Endoscopic Coronary Artery Bypass (TECABG) — Surgeons perform TECAB using the da Vinci® Robotic Surgical System through several small incisions instead of a large chest incision. Small surgical instruments allow your surgeon to perform the procedure with increased precision. The robotic surgical system also has a small camera that is inserted into your body, allowing your surgeon to have a clearer view of your heart. Your surgeon operates the robot from a console equipped with sensitive controls. The robotic arms are very agile and work as an extension of your surgeon's hands.
• Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) with or without Robotic Assistance — Surgeons perform MIDCAB, also sometimes referred to as “keyhole surgery,” through a small incision between the ribs (called a mini thoracotomy) on the left side of the chest. The bypass is performed under direct visualization and may or may not be performed with robotic instruments and a camera. Although minimally invasive techniques do not require a surgeon to open the chest and come with a shorter recovery time, they may not be suitable for people with severe coronary artery disease, or those who need more than one bypass graft.

"Off-pump" CABG surgery

"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.

Minimally invasive vein and artery harvesting for CABG

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.

Conditions we treat with CABG

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:

• Abnormal heart rhythm, such as a racing or fluttering heart.
• Chest pain.
• Labored breathing.

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.

Why Would I Need CABG?

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:

• Other treatments, such as lifestyle changes and medications, have not worked for you.
• Your blocked arteries are severe and cannot be treated with angioplasty.
• You have several blocked arteries.
• You are having symptoms of coronary artery disease.
• You are at high risk of having a heart attack.      

Who’s a candidate for CABG?

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:

• Age.
• Overall health.
• History of heart disease treatment.
• Family history of heart conditions.
• Severity of your heart condition.
• Whether your condition could be treated another way.

People who are older, have certain other medical conditions, or are in poor overall health may not be candidates for the CABG procedure.

Alternatives to CABG

Other treatments for coronary artery disease that may be an alternative to CABG include:

• Lifestyle changes
• Medication
• Angioplasty
• Stenting

What Are the Risks and Complications of CABG?

As with any cardiac surgery, CABG poses risks and complications like:

• Bleeding.
• Abnormal heart rhythms.
• Infection.
• Stroke.

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.

What Should I Expect From CABG?

Before: How to prepare for CABG

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:

• Blood tests.
• Chest CT scan.
• Chest x-ray.
• Echocardiogram.
• Pulmonary function test (a breathing test to evaluate your lungs).
• Ultrasound of the veins and arteries in your legs.

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.

How long does CABG take?

CABG surgery usually takes 2-6 hours, depending on how many bypass grafts you need.

During your CABG surgery

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:

• The number of bypass grafts needed.
• The surgical approach your surgeon chooses.
• The type of vessels harvested.

To create the bypass, your surgeon will:

1. Harvest the healthy artery or vein from another part of your body.
2. Make a cut in the blocked artery on your heart.
3. Sew the new blood vessel on either side of the blockage, allowing blood to flow around the blockage.

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.

Recovery after CABG

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.

When to call your doctor about problems after your surgery

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:

• Chest pain, shortness of breath, leg swelling, or abnormal heart rhythms.
• Redness, swelling, or drainage from your incision site.
• Signs of infection, such as fever, chills, or cough.
• Other symptoms that worry you.

What’s the prognosis after CABG?

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.

What’s the success rate of CABG?

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.

Why Choose UPMC for CABG?

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.

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By UPMC Editorial Staff. Last reviewed on 2024-10-01.