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Department of Surgery Referrals Patient Clinician Researcher

Procedures & Innovations Coronary Artery Bypass Graft

Coronary Artery Bypass Grafting: On- and Off-Pump

Credit: Nancy Heim, Columbia University

Coronary artery bypass grafts (CABG) deliver a new source of blood to regions of the heart served by blocked arteries. Surgeons use segments of the patient's own veins and arteries to go around, or bypass, these blockages. If left untreated, severely blocked arteries may lead to heart attack or death. Coronary bypass operations are performed half a million times a year with an overall success rate of almost 98 percent.

There are two types of CABG operations currently available: on-pump and off-pump surgery. On-pump procedures require the surgeon to open the chest bone (sternum), stop the patient's heart, and place the patient on a heart-lung machine. This machine takes over the function of the patient's heart—delivering oxygenated blood through out the body and brain—while the bypass is performed.

A new, minimal access procedure, the off-pump method eliminates the need for the surgeon to stop the heart and to place the patient on bypass. The surgeon operates directly on the beating heart, reducing the risk for perioperative bleeding and stroke associated with the on-pump procedure. Selection of an on- versus off-pump procedure partly depends on the health of the individual patient.

An important issue in both on- and off-pump CABG is selection of an appropriate conduit (vein or artery) to bring the new blood supply to the heart. Most often, the internal mammary artery, which is located on the inside of the chest wall, serves as the best conduit because it has been shown to last the longest. In 90% of cases, this conduit will last for the rest of the patient's life. During the bypass procedure, the surgeon will take the internal mammary vessel down from inside the chest wall and attach it to the front of the heart. Alternatively, the saphenous vein in the leg may be used as a conduit.

Postoperative care depends on both the type of bypass procedure received and the pace of the patient's recovery. One possible complication is atrial fibrillation, or irregular heartbeats, which occur in about 25% of all heart surgery patients. Typically not dangerous, this condition typically happens in older patients. Other complications include fevers, pain, and drainage from your wounds.

During your postoperative stay, patient education about medications and risk factors is vital in order to ensure a full recovery. These modifications include the permanent cessation of cigarette smoking, appropriate dietary modifications, careful management of diabetes and high blood pressure, and an overall approach to life that results in a less stressful and happier existence.

Dr. Craig Smith - What is an off-pump coronary artery bypass surgery?

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