Coronary Artery Bypass Grafting (CABG) is the most commonly performed open heart surgical procedure in the United States. The operation is one of the most effective treatments for ischemic heart disease, or coronary artery disease, which develops as a result of the accumulation of blockages made of atherosclerotic plaque within the coronary arteries, the arteries that deliver blood to the heart muscle itself. Ischemic heart disease commonly leads to the development of symptoms such as chest pain (angina pectoris) or shortness of breath with exertion, and it may cause a heart attack (myocardial infarction) or the development of congestive heart failure. Ischemic heart disease remains one of the leading causes of death in the United States.
Coronary Artery Bypass Grafting (CABG) is most commonly performed through a vertical incision in the middle of the chest (median sternotomy), although on occasion it can be performed using minimally invasive techniques. Portions of arteries and/or veins taken from other locations in the body are used to construct new conduits (bypass grafts) for blood to traverse around blockages and reach portions of the heart in need of improved blood supply. Arteries for grafting are obtained from the inside of the patient’s chest wall (internal mammary artery) and occasionally the forearm (radial artery), whereas portions of vein are removed from one or both lower extremity (saphenous vein), frequently using endoscopic vein harvest technique. The bypass grafts are typically constructed while the heart is temporarily held motionless using a heart-lung machine to support the patient’s circulation, although on occasion the procedure is performed while the heart is beating (Off-Pump Coronary Artery Bypass Grafting).
Alternative therapies for the treatment of ischemic heart disease include medications alone and percutaneous coronary interventions (PCI) such as balloon angioplasty with or without intracoronary stents. Which therapy is best for any given patient depends upon a variety of individual patient variables. However, in general it has been demonstrated that coronary artery bypass grafting is associated with the greatest benefit in patients with coronary artery disease involving the left main coronary artery and/or multiple proximal vessels, particularly in patients with weakened heart function and/or diabetes mellitus. Following successful coronary artery bypass grafting patients may expect improved symptoms, decreased risk of future heart attack, and improved long term survival.
Risks associated with coronary artery bypass surgery depend upon individual patient variables. However, overall risks remain remarkably low for most patients in the hands of surgeons practicing in quality high-volume centers, such as Cone Health System and the members of Triad Cardiac and Thoracic Surgeons. Our program has consistently been awarded the highest designation (3-star rating) for overall CABG composite quality by the Society of Thoracic Surgeons (STS) every year since the rating system was first reported by the STS National Adult Cardiac Surgery Database.