State of the Art: Coronary Artery Bypass Surgery Center

Overview

Coronary Artery Bypass Surgery

Cleveland Clinic’s Coronary Artery Bypass Surgery Center offers a variety of surgical treatment options for patients with coronary artery disease (CAD). Our team offers expertise and experience to provide an individual plan of care with the best outcomes possible for coronary artery bypass graft surgery (CABG).

Cleveland Clinic has a long history of innovation in the treatment of patients with CAD. In 1958, cardiologist F. Mason Sones Jr., MD, discovered moving cine-coronary angiography (also called cardiac catheterization). And 9 years later, Dr. Rene Favaloro performed the first coronary artery bypass surgery using the vein from a patient’s leg. Again, in 1986, Cleveland Clinic heart surgeons published the landmark paper noting the superiority of using the internal mammary artery in CABG procedures. Dr. Faisal Bakaeen, Director of the Coronary Artery Bypass Surgery Center, is one of the lead authors of the Society of Thoracic surgeons Clinical Practice Guidelines on Arterial Conduits for Coronary Artery Bypass Grafting exemplifying Cleveland Clinic’s role in leading the way for the highest standard of care for our patients.

Since that time, coronary artery bypass grafting (also called CABG) has expanded to include a variety of innovative procedures to meet the needs of all patients, from those who are low risk to the sickest with the highest risk of complications.

Why choose Cleveland Clinic?

Cleveland Clinic is nationally ranked and globally recognized as the world leader in cardiovascular care, and our outcomes are among the best in the nation.

By the numbers

• 1967: Year that CABG was introduced to the world by Cleveland Clinic
• Greater than 100,000: CABGs performed since inception
• 1,938 CABG procedures performed in 2023 (1/3 of all of our heart surgeries)
• Less than 1% = Operative mortality
• x3: More use of durable multi-arterial CABG compared to other centers
• 100%: Commitment to top quality care over the years and a patient-centered approach
• World-class expertise in:
• Complex cases
• High risk cases
• Reoperations
• Robotic CABG
• Minimally invasive direct coronary artery bypass (MIDCAB)
• Cutting edge research and clinical trials

Who We Treat

We treat patients with coronary artery disease, including patients:

• Of all ages – from young patients with premature heart disease to elderly patients
• Who have coronary artery blockage in one or more vessels
• Who are high risk (have other medical conditions, reoperations, or poor heart function)
• Who have more than one type of heart disease (such as valve disease, atrial fibrillation) and need multiple treatments during heart surgery
• Who have had prior treatment for CAD, such as CABG, angioplasty and stents

Our surgical team works very closely with our cardiologists to plan the best treatment for each patient.

Care from before your surgery through your hospital stay

Cardiologists and surgeons work together to determine the best approach for your care. Your healthcare team includes your surgeon, nurse practitioners, physician assistants, nurses, respiratory therapists, cardiac rehabilitation specialists, dietitians, care coordinators and other specialists as needed. They will help you prepare for surgery, support you through your recovery, and be ready for your return home.

Cleveland Clinic’s commitment to your care continues after you leave the hospital. You will have access to a 24/7 nurse line to call with any questions or concerns you have. We want to make sure you have the care you need and the best experience possible.

Procedures

Coronary Artery Bypass Surgery Procedures at Cleveland Clinic

Multiple Arterial Coronary Artery Bypass Graft Surgery

Many patients who need coronary artery bypass surgery need treatment for problems in more than one artery. Cleveland Clinic surgeons are experienced at providing the best outcomes to every patient, no matter how many vessels are involved in the surgery. The use of a second or third arterial graft (instead of venous grafts) is encouraged at Cleveland Clinic, and adopted more than most other cardiac centers around the country. The use of arterial grafts is associated with improved outcomes and prolonged survival based on groundbreaking research from our institution.

Coronary Artery Bypass Graft Surgery Reoperations

Cleveland Clinic’s coronary artery bypass surgery program is the largest in the country for reoperations. Twelve percent of patients who have coronary artery bypass surgery at Cleveland Clinic are patients who have had the surgery in the past. Despite the increased risk of reoperations, our surgeons maintain a low (less than 1%) mortality rate for these procedures.

High-Risk Coronary Artery Bypass Surgery

At Cleveland Clinic, about one half of patients who have coronary artery bypass procedures have another procedure at the same time. These include aortic valve, mitral valve, aorta and other surgeries. Combination procedures are more complex than isolated (solo) procedures and increase the risk of complications. However, the in-hospital mortality rate for these procedures was lower than expected at Cleveland Clinic. In addition, Cleveland Clinic surgeons safely perform coronary artery bypass surgery on patients with poor left ventricular function and other medical conditions.

Off-Pump Coronary Artery Bypass Surgery

Off-pump coronary artery bypass surgery, also called “beating heart” surgery, is coronary artery bypass surgery that is done without a cardiopulmonary bypass machine. This procedure is ideal for patients who have an increased risk of complications with the use of a cardiopulmonary bypass machine.

Smaller Incisions

Cleveland Clinic heart surgeons use the smallest incisions possible during surgery. This includes smaller midsternal incisions when possible and endoscopic approaches when harvesting the saphenous vein (in the leg) or radial artery (in the arm) for the bypass. Endoscopic approaches use very small incisions, which cause less discomfort and shorten recovery time.

Robotic Coronary Artery Bypass Surgery

Cleveland Clinic offers two robotic approaches. Robotically assisted LIMA-LAD is for those who need only a single bypass to the LAD. We also offer a hybrid procedure for patients who have multivessel disease.

Minimally Invasive Direct Coronary Artery Bypass Surgery (MIDCAB)

Our Surgeons

Faisal Bakaeen, MD
Director

Kenneth McCurry, MD

Staff

Nicholas Smedira, MD

Staff

Edward Soltesz, MD

Staff

Michael Zhen-Yu Tong, MD

Staff

Shinya Unai, MD

Staff

Donna Kimmaliardjuk, MD

Associate Staff

Appointments

If you would like information about surgical treatment options for coronary artery disease at Cleveland Clinic, we offer patients the ability to send in medical records for a review. The process involves several steps:

• Contact the Heart Surgery Department at toll free 877.843.2781 (877 8HEART1).
• The intake team will get information from you, give you a list of information needed to complete the surgical review, and tell you how to send in your information.
• You will send in your records to be reviewed by one of our surgeons.
• The surgeon’s office will call you to let you know about your treatment options. The process generally takes a couple weeks after we receive your films, unless your doctor determines that you need surgery right away.
• If you decide to have surgery at Cleveland Clinic, we will give you a surgery date. In some cases, you will see the surgeon for a consultation and surgery will be scheduled after the appointment.

What to expect during your appointment

You will need to arrive a few days before your surgery to have a full evaluation and meet your surgical team. You and your family will attend a program to learn what to expect before, during and after your surgery. See Heart Surgery at Cleveland Clinic for more information about having surgery at Cleveland Clinic.

How long will you need to stay at Cleveland Clinic?

Your hospital stay depends on many factors, such as your condition, the type of procedure(s) you need and your medical history. Generally, patients who live outside of the Cleveland area come to Cleveland a day or two before surgery, stay in the hospital 5 to 7 days, and stay in Cleveland a few days after they leave the hospital. We ask that you return to Cleveland Clinic for a visit during the first week after you leave the hospital (post-op visit) to make sure everything is ok and that you are on the right medications before you go home.

Follow-up

You will need to have follow-up visits for 6 months to a year after surgery. Your doctor will let you know how often you need to be seen.

Traveling to Cleveland Clinic

We want to make traveling to Cleveland Clinic as easy as possible. Learn more on traveling to the Miller Family Heart, Vascular & Thoracic Institute.

Videos

Surgical videos for coronary arteries

Some videos may include real surgery images and may be graphic.

Video Playlist

1. Coronary Artery Bypass Surgery: Internal Mammary Arteries, featuring Faisal Bakaeen, MD
2. Endovascular Radial Artery Harvesting, featuring Jose Navia, MD

References

1. Right or Left Internal Thoracic Artery to the Left Anterior Descending: Informed Choice or Flip a Coin.
   Bakaeen FG.Ann Thorac Surg. 2020 Jun 1:S0003-4975(20)30778-5. doi: 10.1016/j.athoracsur.2020.04.047. Online ahead of print.
2. Coronary Artery Bypass Graft Patency and Survival in Patients on Dialysis.
   Siddiqi S, Ravichandren K, Soltesz EG, Johnston DR, Roselli EE, Tong MZ, Navia JL, Elgharably H, Ayyat K, Houghtaling PL, Pettersson GB, Blackstone EH, Svensson LG, Bakaeen FG.J Surg Res. 2020 May 7;254:1-6. doi: 10.1016/j.jss.2020.03.069. Online ahead of print.
3. Commentary: Coronary artery bypass grafting as a subspecialty: Hype or reality.
   Bakaeen FG, Johnston DR, Svensson LG.J Thorac Cardiovasc Surg. 2020 Apr 18:S0022-5223(20)30903-X. doi: 10.1016/j.jtcvs.2020.04.013. Online ahead of print.
4. Coronary Artery Target Selection and Survival After Bilateral Internal Thoracic Artery Grafting.
   Bakaeen FG, Ravichandren K, Blackstone EH, Houghtaling PL, Soltesz EG, Johnston DR, Mick SL, Navia JL, Tong MZ, McCurry KR, Akhrass R, Abdallah M, Pettersson GB, Smedira NM, Roselli EE, Gillinov AM, Svensson LG.J Am Coll Cardiol. 2020 Jan 28;75(3):258-268. doi: 10.1016/j.jacc.2019.11.026.PMID: 31976863
5. Arterial Grafts for Coronary Bypass: A Critical Review After the Publication of ART and RADIAL.
   Gaudino M, Bakaeen FG, Benedetto U, Di Franco A, Fremes S, Glineur D, Girardi LN, Grau J, Puskas JD, Ruel M, Tam DY, Taggart DP; ATLANTIC (Arterial Grafting International Consortium) Alliance members.Circulation. 2019 Oct 8;140(15
6. CABG: A continuing evolution.
   Bakaeen F.Cleve Clin J Med. 2017 Dec;84(12 Suppl 4):e15-e19. doi: 10.3949/ccjm.84.s4.04. Review.
7. Natural History of Moderate Coronary Artery Stenosis After Surgical Revascularization.
   Raza S, Blackstone EH, Houghtaling PL, Olivares G, Ravichandren K, Koprivanac M, Bakaeen FG, Sabik JF 3rd. Ann Thorac Surg. 2017 Dec 21. pii: S0003-4975(17)31203-1. doi: 10.1016/j.athoracsur.2017.08.053. [Epub ahead of print]
8. Randomized comparison of the clinical outcome of single versus multiple arterial grafts: the ROMA trial-rationale and study protocol.
   Gaudino M, Alexander JH, Bakaeen FG, Ballman K, Barili F, Calafiore AM, Davierwala P, Goldman S, Kappetein P, Lorusso R, Mylotte D, Pagano D, Ruel M, Schwann T, Suma H, Taggart DP, Tranbaugh RF, Fremes S. Eur J Cardiothorac Surg. 2017 Dec 1;52(6):1031-1040. doi: 10.1093/ejcts/ezx358.
9. Similar Outcomes in Diabetes Patients After Coronary Artery Bypass Grafting With Single Internal Thoracic Artery Plus Radial Artery Grafting and Bilateral Internal Thoracic Artery Grafting.
   Raza S, Blackstone EH, Houghtaling PL, Koprivanac M, Ravichandren K, Javadikasgari H, BakaeenFG, Svensson LG, Sabik JF 3rd. Ann Thorac Surg. 2017 Dec;104(6):1923-1932. doi: 10.1016/j.athoracsur.2017.05.050. Epub 2017 Aug 18.
10. Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass.
    Shroyer AL, Hattler B, Wagner TH, Collins JF, Baltz JH, Quin JA, Almassi GH, Kozora E, Bakaeen F, Cleveland JC Jr, Bishawi M, Grover FL; Veterans Affairs ROOBY-FS Group. N Engl J Med. 2017 Aug 17;377(7):623-632. doi: 10.1056/NEJMoa1614341.
11. Tailoring Operations to the Patient Is Always Best.
    Bakaeen FG, Sabik JF 3rd. Circulation. 2016 Oct 25;134(17):1221-1223. No abstract available.
12. The Society of Thoracic Surgeons Clinical Practice Guidelines on Arterial Conduits for Coronary Artery Bypass Grafting.
    Aldea GS, Bakaeen FG, Pal J, Fremes S, Head SJ, Sabik J, Rosengart T, Kappetein AP, Thourani VH, Firestone S, Mitchell JD; Society of Thoracic Surgeons. Ann Thorac Surg. 2016 Feb;101(2):801-9. doi: 10.1016/j.athoracsur.2015.09.100. Epub 2015 Dec 8.
13. Is reoperation still a risk factor in coronary artery bypass surgery?
    Sabik JF 3rd, Blackstone EH, Houghtaling PL, Walts PA, Lytle BW. Ann Thorac Surg. 2005 Nov;80(5):1719-27.
14. Two internal thoracic artery grafts are better than one.
    Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R, McCarthy PM, CosgroveDM. J Thorac Cardiovasc Surg. 1999 May;117(5):855-72.
15. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events.  Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC, et al. N Engl J Med. 1986 Jan 2;314(1):1-6.

More Information

If you need more information, click here to contact us, chat online with a nurse or call the Heart, Vascular & Thoracic Institute Resource Nurses at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.