Surgical & Heart Information

A coronary artery bypass grafting (CABG) surgery is used to improve blood flow to the heart in people with severe coronary artery disease (CAD). This is the most common type of open-heart surgery in the United States. A coronary artery bypass graft (CABG) creates new routes around narrowed and blocked arteries, allowing sufficient blood flow to deliver oxygen and nutrients to the heart muscle. The chest is opened up for complete access to the heart and put on a heart-lung bypass machine during the operation. However, there are several newer, less invasive techniques for coronary artery bypass surgery that can be used instead of open-chest surgery in some cases. One method of these minimally invasive techniques, is an off-pump-coronary bypass (OPCB). This procedure uses smaller openings in the chest and usually does not require a heart-lung machine.

Coronary artery disease (CAD) occurs when atherosclerotic plaque (hardening of the arteries) builds up in the wall of the arteries that supply the heart. This plaque is primarily made of cholesterol. Plaque accumulation can be accelerated by smoking, high blood pressure, elevated cholesterol, and diabetes. Patients are also at higher risk for plaque development if they are older (greater than 45 years for men and 55 years for women), or if they have a positive family history for early heart artery disease. The atherosclerotic process causes significant narrowing in one or more coronary arteries.

A coronary artery bypass graft (CABG) is a procedure performed exclusively by cardiothoracic surgeons. The traditional technique involves an incision down the front of the chest through the breastbone or sternum, called a median sternotomy. Through this incision the surgeon can see the heart and the aorta, and the patient is connected to a heart-lung machine while the bypasses are being performed. For the bypass grafts, Dr. Morales and Dr. Bielefeld will use either an artery or a vein from your body. A vein may be removed from your leg. One end of it is attached to the aorta and the other end to the diseased coronary artery just past the blocked area. One end of a mammary artery or another artery in the chest may be detached and reattached to the coronary artery just past the blocked area. A portion of the radial artery in your forearm may be used. In any case, blood is redirected through the artery or vein graft, detouring the blocked or narrowed artery and increasing blood flow to that region of the heart. After the bypasses have been performed the patient is taken off of the machine and their own heart takes over once again.

Surgery is not an option to be considered lightly. Your cardiologist along with Dr. Mark Morales and Dr. Mark Bielefeld will only recommend a coronary artery bypass graft (CABG) when they believe other options like prescription drugs or balloon angioplasty cannot achieve the goal of keeping a patient healthy.

As with any other surgical procedure, there are certain risks that a patient should be aware of prior to surgery. The magnitude of risks vary according to each patient's specific health conditions. Potential complications of a coronary artery bypass graft (CABG) include bleeding or infection, stroke (which is primarily related to age and history of previous stroke), kidney failure (related in large measure to the kidney function before the surgery), and heart attack during or after the surgery. Please keep in mind that estimates of a particular patient's risk of any of these complications can only be made by the physician taking the individual patient's specific health circumstances into consideration. The risk of complications generally depends upon age, general health, smoking history, specific medical conditions, and heart function.

Although a coronary artery bypass graft does not cure coronary artery disease and does not affect the process of hardening and narrowing arteries (atherosclerosis), it usually relieves patients of chest pain after surgery. Some patients notice an increase in their energy level after recovery and did not realized how much they had been slowing down prior to surgery. Although symptoms may recur, most patients have sustained relief. A minority of patients will require repeat surgery , usually 10 or more years after their original operation. Due to the of a number of improvements in the procedure, most cardiothoracic surgeons feel that fewer and fewer patients will need reintervention in the future.