• Evolution and Types of Coronary Bypass Surgery


    Coronary artery bypass graft surgery has been performed as a treatment for blocked heart arteries for almost 50 years. Its development marked a revolution in heart attack treatment. Prior to the existence of coronary bypass surgery, most heart attack patients were put on bed rest for weeks, and survival rates were low. In the decades since, the surgery has evolved to keep pace with new discoveries in medical research.

    Today, most coronary bypass surgeries are of the “traditional” type, involving use of a heart-lung machine to take over the function of those organs during the procedure and to allow for surgery on a still heart. However, “off-pump” surgeries – those performed on a beating heart without the use of a heart-lung machine – are becoming more common. Additionally, some minimally invasive surgeries are now performed through smaller incisions between the ribs, without the need for open-chest surgery.

    Read on for more information about traditional and off-pump surgery, and for surgeries performed through smaller incisions.

    Traditional Coronary Artery Bypass Graft Surgery

    “Traditional” coronary bypass surgery refers to surgeries that are performed through a 6- to 8-inch incision in the chest and with the use of a heart-lung machine to take over the work of the heart and lungs during the surgery. The surgeon makes the incision in the chest, cuts the sternum (chest bone), and opens the rib cage to access the heart. The patient is given medications to stop the heart from beating, and the heart-lung machine circulates blood throughout the body.

    After the surgeon has sewn blood vessels to detour blood around a blockage in the heart arteries, the patient’s heart will take over again as the heart-lung machine is discontinued. The surgeon will then rewire the sternum closed and close up the incision in the chest.

    This traditional form of coronary artery bypass surgery is well proven and widely practiced. For detailed information about the coronary bypass surgery process, please visit About Your Coronary Bypass Surgery.

    Minimally Invasive Coronary Bypass Techniques

    The term minimally invasive is used to describe a range of newer coronary bypass surgery techniques, including those that do not use a heart-lung machine and surgeries with smaller incisions.

    Off-Pump Coronary Artery Bypass Graft Surgery

    Some coronary bypass surgeries are now performed without the use of a heart-lung machine. For these surgeries, the patient is given medications to slow the heart, but it remains beating. The surgeon attaches devices to stabilize the section of the heart he or she is going to work on. 

    This procedure was developed to minimize some of the complications and side effects of traditional coronary bypass surgery, such as stroke, temporary cognitive problems (memory loss, difficulty in thinking clearly), and bleeding. Research studies have found conflicting results about whether off-pump surgery is better than on-pump surgery. Off-pump and on-pump surgery appear to have similar success rates and similarly low death rates. Off-pump surgery reduces recovery time and seems to reduce the need for blood transfusions. However, patients might be at a slightly higher risk of needing a repeat procedure in the future to reopen blocked blood vessels. Some research has suggested that high-risk patients may be better candidates for off-pump procedures. More research will be needed to determine if there are clear benefits of one procedure over the other for certain types of patients.

    Coronary Bypass Surgery with Smaller Incisions

    Off-pump techniques have made coronary bypass surgeries with smaller incisions possible. For minimally invasive coronary bypass surgery, the surgeon accesses the heart muscle through a 3-inch incision in between the ribs.

    Robotically assisted coronary bypass surgery allows for surgery via several tiny incisions of 2 inches or less. The surgical instruments for the procedure and a tiny camera are placed through the incisions.

    Not all patients are good candidates for minimally invasive coronary bypass surgery with smaller incisions, but when possible, it dramatically reduces recovery time. Most of the long recovery time from traditional coronary bypass surgery is due to the need for the sternum (chest bone) to heal.

    Learn More About Coronary Bypass Surgery

    If you’d like to learn more about coronary bypass surgery, follow the link below:

    • About Your Coronary Bypass Surgery. Information about what to expect before, during, and after your coronary bypass surgery can help you understand the procedure, how to prepare, and what to expect during recovery. Learn more…