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Coronary Artery Bypass Surgery


Coronary artery disease (CAD), sometimes called coronary heart disease (CHD),  is a condition in which plaque, made up of fat, cholesterol, calcium and other elements in the blood, build up inside the arterial walls of the heart. This is known as atherosclerosis (or hardening of the arteries) and is accelerated by smoking, fatty diets, obesity, diabetes and age. Over time, if not removed, plaque can completely clog arteries restricting necessary blood and oxygen flow to the heart which can cause angina (chest pain) or allow blood clots to form that may lead to a heart attack.

After careful assessment, your doctor will decide if coronary artery bypass grafting (CABG) surgery will be the most beneficial course of action for you. He or she may first try other methods such as cholesterol-lowering medications or angioplasty, a technique where a thin tube with a balloon on the end is weaved through the artery to clean out built up plaque, then a small mesh tube, called a stent, is inserted to keep the artery open.

What is a coronary artery bypass graft (CABG)?

CABG is a surgical procedure performed at New York Methodist and used to re-open narrowed or blocked heart arteries thereby increasing blood flow which helps carry oxygen and nutrients to the heart. People with severe coronary artery disease (CAD) are candidates for CABG particularly if lifestyle changes and/or medications have not helped to restore proper function to the heart.

CABG, sometimes referred to simply as heart bypass surgery, is performed by a cardiothoracic surgeon after consulting with your cardiologist. The operation involves taking a healthy vein or artery from either your leg or inner chest wall and grafting (or attaching) it to the diseased artery. The new vein or artery is then used to bypass (or go around) the blocked section of the artery allowing oxygen-rich blood to flow once again directly to the heart muscle.

What are the various types of CABG Surgery?

Today, there are several types of CABG surgery that may be performed and your surgeon will advise which is best for your specific case.

Traditional (or On-Pump) CABG is the most common. It involves opening the chest to expose the heart which is then stopped from beating with medicine while the patient is attached to a cardiopulmonary bypass machine (or heart-lung pump) which circulates purified blood and oxygen through the rest of the body during the operation. This allows the surgical team to perform the bypass on a non-beating heart thereby increasing the stability of the operating field. Up to five major coronary blocked arteries may be bypassed during one operation. After surgery is completed, blood flow is reestablished to the heart and it begins to beat again, usually on its own or through mild electric shock.

Off-Pump CABG surgery is very similar to traditional CABG; however, the heart-lung machine is not used and the heart continues to beat throughout the procedure. By not stopping the heart or using the heart-lung machine, recovery time and the incidence of some complications may be reduced.  At New York Methodist, we also perform off-pump CABG using robot-assisted technology. Robotic surgery provides patients the benefits of a shorter hospital stay and a faster recovery.

The third type of CABG is called Minimally Invasive Direct (or MIDCAB) and is similar to Off-Pump as the heart is not stopped and the heart-lung machine is not used. With this approach, a small incision is created between two ribs on the left side of the chest. Through this small opening, the surgeon will usually create one bypass.

For more information on these procedures, call 718.780.7700.

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