Coronary Artery Bypass Grafting is in many cases the surgical treatment of choice for Coronary Artery Disease (CAD), an occlusion (obstruction) of the coronary arteries resulting from atherosclerosis (arteriosclerosis), a buildup of diseased tissue on the inner wall of the coronary arteries.

When is Coronary Artery Bypass Surgery Indicated?

When the number, location, and extent of coronary artery stenosis injuries (occlusions) present a significant risk of heart attack for the patient, surgery is the preferred method of treatment for CAD. Surgery may also be indicated during or immediately after a heart attack to attempt to salvage damaged heart muscle. The principal methods of surgery for treatment of CAD involve bypassing blockages in coronary arteries with a blood vessel taken from another part of the patient's body. The standard procedure is called Coronary Artery Bypass Grafting (CABG) surgery, or simply coronary artery bypass surgery. Today CABG surgery is one of the most common surgical procedures. Since the first coronary artery bypass operation was done in the 1960's, many improvements in techniques have been developed.

Conventional CABG Surgery

The conventional CABG surgery is done by opening the patient's chest with an incision over the sternum (breast bone) and dividing it to expose the heart. Simultaneously, the greater saphenous vein from one of the patient's legs is "harvested" to be used for the bypass procedure. Bypasses may be performed using different blood vessels. Originally, only the saphenous vein was used as a bypass conduit (graft), but now the vessels of choice are the Internal Mammary Arteries (IMA) because they remain unobstructed far longer than saphenous vein grafts. During the operation the patient's heart is connected to a heart-lung machine which is used to provide circulation and oxygenate the blood while the heart is stopped by the surgeon to work on it. Depending on the number and location of the blockages, the surgeon might perform between one and seven bypasses. When the bypasses are completed, the heart is restarted. Once the heart beats normally the patient is removed from the heart-lung machine and the chest is closed up, the sternum is stabilized with stainless steel wire suture, and the chest and leg wounds are closed with sutures or clips. Typically, recovery is required in intensive care unit (ICU) for approximately two days. Barring any complications, a total hospital stay of seven to ten days can be expected with this type of surgery.

Minimally Invasive Coronary Artery Bypass

Patients with lesions in the Left Anterior Descending (LAD) coronary artery and the Right Coronary Artery (RCA) may benefit from a technique called Minimally Invasive Direct Coronary Artery Bypass (MIDCAB), or "limited access coronary artery bypass." In contrast with conventional CABG, this procedure is done through a smaller incision on the patient's chest over the heart to gain access to the coronary arteries. As the procedure is done in a confined space usually while the heart is beating and without the use of a heart-lung machine, surgeons use different methods to slow down and steady the heart. Since it involves a smaller chest incision than conventional CABG and excludes the use the heart-lung machine, this technique results in fewer complications, less pain after surgery, and more rapid recovery. However, the technique is primarily indicated for patients with lesions on the LAD and the RCA. Whenever possible, the Internal Mammary Artery (IMA) is used to bypass the occlusions. Following the surgery, the patient is taken to the recovery area for approximately 12 to 24 hours. Total hospital stay is usually about 3 to 4 days.

If you have been advised to consider heart bypass surgery, we encourage you to contact us for evaluation. The doctors at Surgical Associates of Texas will use their extensive experience with both types of procedures (conventional and minimally invasive) to evaluate your case and determine the best approach for you. Surgical Associates of Texas, P.A., the surgical team at the Texas Heart Institute, have more experience than any other cardiovascular surgical group in the world, having performed approximately 100,000 open heart surgeries of all types and degrees of complexity and over 600 heart transplants. Many of our patients have had successful operations and recovery when previously led to believe that no further treatment options were possible.