Coronary artery bypass surgery (also called coronary artery bypass grafting or CABG) is a treatment for patients with coronary artery disease.
Coronary artery disease (CAD) is narrowing or blockage of one or more of the coronary arteries that supply oxygen-rich blood to the heart. It is common for three or four coronary arteries to be bypassed during surgery.
Coronary artery bypass surgery restores normal blood flow to the heart by creating a “detour” (bypass) around the blocked artery/arteries. This is done by using a healthy blood vessel, called a graft. Grafts usually come from your own arteries and veins located in the chest, leg or arm. The graft creates a new pathway to carry oxygen-rich blood to the heart.
Do I need coronary artery bypass surgery?
Your heart doctor will order tests to find out more about your coronary artery disease. The results of these tests will be considered along with the structure and function of your heart, your age, your symptoms, other medical conditions you have and your lifestyle. This information will help your cardiologist, surgeon and you determine the best treatment option for you. The goals of the coronary artery bypass surgery are to:
- Relieve your symptoms of coronary artery disease (such as angina [chest discomfort] or shortness of breath)
- Help you return to your normal lifestyle and activities
- Lower your risk of a future heart attack or other heart problems
At Cleveland Clinic, bypass surgery is often performed along with other heart surgeries, such as valve surgery, aortic aneurysm surgery or surgery to treat atrial fibrillation (an abnormal heart beat).
Types of coronary artery bypass grafts
Internal thoracic arteries (also called ITA grafts or internal mammary arteries [IMA]) are the most common bypass grafts used. They are the standard of care, and the goal is to use these arteries for every patient who has isolated coronary artery bypass surgery. The ITAs result in the best long-term results (for more information about performance, see STS star-ratings). You have two internal thoracic arteries in your chest. If these arteries are used for bypass surgery, they can usually be kept intact at their origin because they have their own oxygen-rich blood supply. The other end is cut and sewn to the coronary artery below the site of the blockage. If the artery needs to be completely removed, it is called a “free” artery.
The radial (arm) artery is another common type of arterial graft. There are two arteries in the arm, the ulnar and radial arteries. The ulnar artery delivers blood to the arm, so most people do not have any side effects if the radial artery is used as a graft. If your surgeon decides to use your radial artery, you will have tests before and during surgery to make sure this is the best option. If the radial artery is used as the graft, you may need to take a calcium channel blocker medication for several months after surgery. This medication helps keep the artery open. Some people who have radial artery bypass grafts have numbness in the wrist after surgery. But, this sensation usually goes away. This type of graft is known to have good results, although long-term outcomes are not fully known. Less commonly used arteries are the gastroepiploic artery, which is a branch leading to the stomach, and the inferior epigastric artery, which leads to the abdominal wall. These arteries are more difficult to use, but can be a good option if other arteries cannot be used.
Saphenous veins are veins in your legs that can be used as bypass grafts. Minimally invasive saphenous vein removal does not require a long incision. Instead, 1-2 incisions are made at the knee and a small incision is made at the groin. This type of removal leads to less scarring and a faster recovery than traditional surgery. Although much has been done to improve the results with vein grafts, they still tend to fail in the long term.
What is the best type of graft for me?
Your surgeon will determine the right type of bypass graft for you. The choice depends on many factors, including the location and extent of the blockage, size of the coronary arteries, availability of arteries and veins, your age and other medical conditions you have.