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Coronary artery bypass graft surgery, or CABG surgery, is a procedure that brings healthy blood flow back to the heart.

According to the National Heart, Lung, and Blood Institute, CABG is the most common type of open-heart surgery in the United States.

What Is Coronary Artery Disease?

Your coronary arteries bring blood to your heart to pump out to the rest of your body. Coronary artery disease happens when plaque, which consists of cholesterol, fatty deposits, calcium, and other substances, builds up on your artery walls.

Plaque can harden and narrow — if not completely block — your arteries. It can also break apart, causing clots that block blood flow.

Symptoms of coronary artery disease can include:

  • Chest pain.
  • Pain or pressure in your shoulders, neck, arms, back, or jaw.
  • Shortness of breath.

In some cases, the first sign of coronary artery disease is a heart attack, a serious (and potentially fatal) medical emergency. If you think you or someone else is having a heart attack, call 911 right away. Prompt treatment during a heart attack can save a person’s life.

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How Do You Treat Coronary Artery Disease?

In some cases, coronary artery disease improves with lifestyle changes and medicines. Procedures like angioplasty can help open up a blocked artery using a catheter and balloon.

If these treatments don’t work for you, your doctor may suggest CABG.

What Is Coronary Artery Bypass Graft Surgery?

Coronary artery bypass graft surgery is an operation that creates a new route for blood to flow around a blocked artery. During a CABG procedure, a surgeon takes a healthy artery or vein from another part of your body — called a graft. They use this to bypass the blocked artery so blood can flow properly.

Depending on the number of blocked arteries, you may need more than one bypass. For example, if you’ve heard someone say they had triple bypass surgery, that means they had three bypasses created.

What Are the Types of CABG?

Alternatively, depending on your condition and medical history, your surgeon may choose to perform:

  • Traditional CABG procedure. Surgeons open your chest, stop your heart, and graft new arteries onto your heart. Traditional CABG requires a large incision through the breastbone (sternotomy) to directly access the heart.
  • Off-pump CABG surgery. This is similar to traditional CABG surgery, but your surgeon won’t stop your heart. Instead, they’ll use a device to control your heartbeat during the procedure.
  • Minimally invasive direct coronary artery bypass (MIDCAB) graft surgery. This is an alternative to traditional or off-pump bypass surgery. The surgeon makes small incisions between the ribs to access the heart. It doesn’t require open heart surgery or a bypass machine. Sometimes called robotic CABG, this procedure uses robotic devices, cameras, and precision instruments.

Robotic versus traditional CABG

There are many differences between CABG and a bypass. Robotic CABG is less invasive. You’ll have a shorter hospital stay — three to five days with a MIDCAB compared to at least seven days for traditional CABG.

Minimally invasive robotic heart surgery also has faster recovery times compared to traditional CABG. People tend to experience less pain and scarring with the robotic approach.

Both approaches have similar long-term outcomes, such as survival and freedom from major adverse events.

Which type of CABG is right for me?

Several factors determine which procedure is suitable for a particular patient:

  • Surgeons with more experience in robotic techniques are more likely to offer this approach to a broader range of patients.
  • Overweight people, especially those with prior chest surgery or who have severe lung disease, aren’t always ideal candidates for robotic CABG in some circumstances.
  • Younger, healthier people may benefit more from the minimally invasive robotic approach.

The most critical factors are individual health status, the extent of coronary artery disease, and the experience and recommendations of the cardiac surgeon.

What Happens During CABG Surgery?

No matter what type of heart surgery you get, your medical team will administer anesthesia to put you to sleep during the procedure. A team of experts — including a surgeon, an anesthesiologist, and nurses — will care for you throughout your surgery.

Here’s what happens during various CABG procedures.

Traditional CABG

During a traditional “open-heart” CABG procedure, the surgeon makes a large cut in the chest and breastbone to open the rib cage. Medicine stops your heart, and a heart-lung bypass machine takes over the work of the heart and lungs to move blood through the body.

The surgeon takes a graft from a healthy artery or vein, usually in the chest or leg, and sews it around the blocked artery to make a new route for blood to flow. When the graft is in place, the doctor restarts the heart and removes the heart-lung bypass machine. The surgeon will close the breastbone with wire and the chest with stitches or staples.

Robotic CABG

During a robotic or less invasive CABG procedure, you’ll get general anesthesia through an IV, so you’re asleep during the operation.

Surgeons will make several keyhole-sized incisions between the ribs on the left side of your body instead of through your breastbone. They usually won’t have to put you on a bypass machine for robotic surgery.

The robotic arms insert tiny instruments to complete the bypass. These tools are extremely precise and act as an extension of the surgeon’s hand. A tiny video camera provides a real-time image of the operating site.

Surgeons control the robotic arms from a console in the operating room. After doctors attach the bypass blood vessel, they remove the instruments and close the incisions. This surgery may take longer than conventional CABG.

What Happens After CABG Surgery?

For most people, recovery after CABG surgery takes about six to 12 weeks. How long exactly depends on which type of surgery you had and your overall health. Recovery is a gradual process that’ll require some rehabilitation time.

With traditional open-heart surgery, you’ll stay in the hospital for about a week. With less invasive options, you’ll probably stay five days or less.

After you go home, your doctor will give you information about how to care for your incisions. They’ll also give you information about how you might feel in the days ahead and when to seek medical help if you need it.

Your doctor will also talk with you about when you can get back to your normal activities. They’ll likely suggest a cardiac rehabilitation program to help you recover. Research has shown that participating in such programs improves outcomes and quality of life after surgery.

CABG surgery is usually successful, but developing blockages in other arteries is possible. Your doctor will give you medicines and suggest lifestyle changes that can help you lower your risk of blocked arteries in the future.

Editor's Note: This article was originally published on , and was last reviewed on .

About Heart and Vascular Institute

The UPMC Heart and Vascular Institute has long been a leader in cardiovascular care, with a rich history in clinical research and innovation. As one of the first heart transplant centers in the country and as the developer of one of the first heart-assist devices, UPMC has contributed to advancing the field of cardiovascular medicine. We strive to provide the most advanced, cutting-edge care for our patients, treating both common and complex conditions. We also offer services that seek to improve the health of our communities, including heart screenings, free clinics, and heart health education. Find an expert near you.