Coronary Artery Bypass Graft Surgery

Medical College of Wisconsin cardiac surgeons are experts in performing all forms of coronary artery bypass graft surgery.

Coronary Artery Bypass Grafting (CABG) involves removing healthy arteries and/or veins from one part of the body and attaching or grafting them to the coronary artery to restore blood flow to the heart.

Following are some of the bypass surgery techniques for treating coronary artery disease.

Traditional CABG. Involves making a 6- to 8-inch incision down the center of the chest, cutting the breastbone (sternum) and opening the chest to reach the heart. One or more healthy arteries and/or veins are removed from another part of the body, often the leg. The surgeon attaches the blood vessel(s) to the coronary artery above and below the narrowed or blocked area. The grafted vessel bypasses the blocked portion of the coronary artery, allowing oxygen-rich blood to reach the heart. During the procedure, the heart is stopped, and a heart-lung machine keeps blood moving throughout the body.

Off-pump (“beating heart”) CABG. Like traditional CABG, beating heart surgery involves cutting through the sternum. This procedure, however, is done without stopping the heart or using a heart-lung machine. Instead, surgeons steady the part of the heart where a bypass is needed with a special device. The heart continues to pump blood to the body during surgery.

Minimally invasive CABG. Minimally invasive direct coronary artery bypass (MIDCAB) may be done when only one or two artery bypasses are needed. A 2- to 3-inch incision is made in the chest without splitting the sternum. Through the incision, the surgeon connects a bypass vessel to a diseased coronary artery. This surgery is performed without using a heart-lung machine.

Redo CABG. Over time (10 or more years), 10 percent to 15 percent of people who had CABG surgery need to have another bypass procedure. This may be caused by narrowing of the grafted arteries or worsening of the person’s coronary artery disease.

Endovascular vein harvesting. Traditionally, surgeons harvest a vein from the patient’s leg to use as the bypass graft. This procedure usually requires an incision the length of the patient’s leg. Our physicians are skilled at minimally invasive endovascular (or endoscopic) vein harvesting, a procedure that leads to less pain, fewer wound complications and a better cosmetic outcome.

Transmyocardial LASER revascularization (TMR). A procedure for patients with inoperable coronary artery disease and angina (chest pain). TMR can improve blood flow to areas of the heart that cannot be treated by angioplasty or surgery. A special laser is used to create small channels in the heart muscle to improve blood flow. This surgical procedure is performed through a small incision on the left side of the chest or through the sternum. TMR may be performed with coronary artery bypass surgery or as an independent procedure.

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