Coronary Artery Bypass Surgery

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, but essentially there are two types of coronary artery bypass techniques: the conventional, or open chest, and the minimally invasive.

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. 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. Typically, recovery is required in intensive care unit (ICU) for approximately two days, and a total hospital stay of seven to ten days can be expected with this type of surgery. For more information on CABG please click here.

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 usually done through a smaller incision on the patient's chest while the heart is beating and without the use of a heart-lung machine. This technique results in fewer complications, less pain after surgery, and more rapid recovery. 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 approximatley 12 to 24 hours. Total hospital stay is usually about 3 to 4 days. For More Information on MIDCAB, please click here.

Transmyocardial Laser Revascularization (TMLR)

This is one of the latest approaches in treating CAD that offers a new alternative to patients with a very serious condition. It has been under evaluation by the FDA for several years, and its use has been restricted to patients who have severe unstable angina and who cannot be helped with medication or any other form of intervention. However, now it is available to patients with badly diseased arteries based on their doctor's judgment. Click here for more information on TMLR.

Which Procedure is the Most Appropriate?

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 these procedures 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.

Our surgeons are distinguished by their extensive experience in coronary bypass surgery, valvular repair and replacement, aortic and left-ventricular aneurysm surgery, and successful outcomes with high-risk patients with multiple disease comorbidities. They are deeply involved in clinically oriented research where advances and developments are transferred directly to patient care, and have long term relationships with an excellent team of cardiovascular anesthesiologists and cardiologists. Based at the Texas Heart Institute, our surgeons are affiliated with St. Luke's Episcopal Hospital, and Texas Children's Hospital. They hold academic appointments at The University of Texas Medical School, Houston, and Baylor College of Medicine, Houston.