Treating Heart Disease

When your coronary arteries are blocked, your doctor may treat the problem by giving the blood a new pathway to the heart.

During coronary artery bypass graft surgery (also called CABG, or "cabbage") a blood vessel is removed or redirected from one area of the body and placed around the area or areas of narrowing to "bypass" the blockages and restore blood flow to the heart muscle. This vessel is called a graft.

These substitute blood vessels can come from your chest, legs, or arms. They're safe to use because there are other pathways that take blood to and from those tissues. The surgeon will decide which graft(s) to use depending on the location of your blockage, the amount of blockage and the size of your coronary arteries.

Heart Failure - CABG

CABG surgery is among the most common operations performed in the U.S., with more than 500,000 performed each year. It is the most common open heart surgery performed in the U.S.
Which Arteries Are Used for Coronary Grafts?

There are several types of bypass grafts. The surgeon decides which graft(s) to use, based on the location of the blockage, the amount of blockage, and the size of the patient's coronary arteries.

* Internal mammary arteries (also called thoracic arteries): These are the most common bypass grafts used, as they have been shown to have the best long-term results. In most cases, these arteries can be kept intact at their origin since they have their own oxygen-rich blood supply. During the procedure, the arteries are sewn to the coronary artery below the site of blockage. This artery is located in the chest and can be accessed through the primary incision for the bypass surgery.
* Saphenous veins: These veins are removed from your leg, and then sewn from your aorta to the coronary artery below the site of blockage. Minimally invasive saphenous vein removal may be performed and results in less scarring and a faster recovery.
* Radial artery: There are two arteries in the lower part of the arm, the ulnar and radial arteries. Most people receive adequate blood flow to their arm from the ulnar artery alone and will not have any side effects if the radial artery is removed and used as a graft. Careful preoperative and intraoperative tests determine if the radial artery can be used. If you have certain conditions (such as Raynaud's, carpal tunnel syndrome or painful fingers in cold air) you may not be a candidate for this type of bypass graft. The radial artery incision is in your forearm, about 2 inches from your elbow and ending about 1 inch from your wrist. If you have this type of bypass, you will probably be prescribed a medication called a calcium channel blocker for about six months after surgery to help keep the radial artery open. Some people report numbness in the wrist after surgery. However, long-term sensory loss or numbness is uncommon.
* The gastroepiploic artery to the stomach and the inferior epigastric artery to the abdominal wall are less commonly used for grafting.

It is common for three or four coronary arteries to be bypassed during surgery. A coronary artery bypass can be performed with traditional surgery (see below) or with minimally invasive surgery (see below). Your surgeon will review your diagnostic tests prior to your surgery to see if you are a candidate for minimally invasive bypass surgery.
How Is Traditional Bypass Surgery Performed?

During traditional CABG, a surgeon makes an incision (about 6 to 8 inches) down the center of your sternum (breastbone) to get direct access to your heart. You are connected to a heart-lung bypass machine, which allows for circulation of blood throughout your body during surgery. The heart is stopped and the surgeon then performs the bypass procedure described above.

After surgery, the surgeon closes the breastbone with special sternal wires and the chest with special internal or traditional external stitches.

During surgery, the heart-lung bypass machine (called "on-pump" surgery) is used to take over for the heart and lungs, allowing the circulation of blood throughout the rest of the body. The heart's beating is stopped so the surgeon can perform the bypass on a "still" and bloodless heart.