Coronary artery bypass graft (CABG) surgery is a major heart operation performed on more than a half-million people each year. This treatment for coronary artery disease uses blood vessels from the patient’s chest or leg to go around or “bypass” clogged coronary (heart) arteries. One end of a vessel is attached to the aorta (the large artery that carries blood from the heart), and the other end is attached to the coronary artery below the point at which it’s blocked. The new channel allows blood to flow to the heart.
Traditional CABG surgery requires a large incision dividing the breastbone. Most patients are placed on a heart-lung machine, which reroutes the blood outside the body, oxygenates it and returns it to the body, so the heart is not moving during surgery. Recovery time is approximately four to eight weeks after surgery.
Better Techniques, Better Outcomes
Over the years, Barnes-Jewish & Washington University Heart & Vascular Center surgeons have performed bypass surgery using different techniques and grafting materials. Grafting uses tissue that is transplanted or implanted in part of the body to repair a defect. Vein grafts proved deficient because they developed accelerated atherosclerosis, so that 10 years after surgery half the grafts had failed. Atherosclerosis occurs when plaque accumulates on the walls of the arteries narrowing the space for blood to flow through. This leads to increased risk of blood clots and an enlarged heart because of the extra pumping effort required.
Arterial conduits, or surgically constructed channels connecting arteries, are more durable, especially those involving the internal thoracic artery (ITA). They show no evidence of atherosclerosis even 25 years after surgery.
Dr. Hendrick Barner, a Heart & Vascular Center heart surgeon, has used arterial conduits, most recently the radial artery, and pioneered a successful bypass procedure called the radial artery T-graft. The technique, which he developed in 1993, has been adopted at other centers around the country.
This procedure offers several advantages over other methods. It takes less time than conventional arterial grafting, since the ITA and the radial artery can be harvested at the same time. That also means a decreased risk of infection in the incision. And diabetics and others with poor circulation can especially benefit from this procedure, which does not require the use of leg veins that may sometimes be needed for peripheral blood vessel reconstruction.
In addition to traditional CABG surgery, heart surgeons perform off-pump coronary artery bypass (OPCAB), which may help patients avoid some neurological deficits, shorten recovery time and reduce the risk of pulmonary complications. For patients who need only a single bypass (one artery to repair), endoscopic coronary artery bypass also may be an option. Benefits of this less invasive technique include less postoperative pain, a shorter hospital stay and a shorter recovery period.
After CABG surgery, our clinicians use evidence-supported practices to reduce major complications such as wound infections, arrhythmias, hemorrhage and stroke. They also take other proven steps to optimize CABG outcomes including:
an active program of physical rehabilitation starting the first day after surgery
smoking cessation encouragement
use of medications such as aspirin with 48 hours of surgery
statin drugs to control cholesterol
long-term use of beta-blockers (drugs that slow heart rate and lower high blood pressure) and ACE inhibitors (drugs that also control blood pressure)
To make an appointment with a Washington University heart or vascular specialist at Barnes-Jewish Hospital, call