Why Choose Penn Medicine
Penn's cardiac surgeons lead the way when it comes to coronary artery bypass graft (CABG) surgery. Our nationally recognized surgeons treat many patients whose complex needs could not be treated at other centers. Other differentiators include:
- Ranked program: U.S. News & World Report rates our surgeons as high performing in heart bypass surgery. They note that our patients have excellent survival because we perform a very high number of heart surgeries.
- Arterial grafts: We only use arteries to create bypass grafts. This approach, known as total arterial revascularization, is the gold standard. Studies show arteries used for bypass grafts have better longevity than veins.
- Re-operative success: Up to 10 percent of patients need to have a repeat CABG operation. Our success rate is near 97 percent for these technically challenging procedures.
- Lower stroke risk: Penn heart specialists developed advanced techniques to reduce the stroke risk for patients who are supported by a heart-lung machine.
- Team approach: Our surgeons, cardiologists and robust nursing team ensure you receive the comprehensive care you need before, during and after surgery. Meet our treatment team.
- Pain control: Cardiovascular anesthesiologists develop an effective pain management plan for every patient. This approach decreases narcotic use and minimizes postoperative pain.
- Earlier discharge: Our surgical approach ensures patients have less bleeding and get extubated and discharged sooner.
- Quality Rating: The Hospital of the University of Pennsylvania (HUP) has earned a distinguished three-star rating from The Society of Thoracic Surgeons for its patient care and outcomes in isolated coronary artery bypass grafting (CABG) procedures. The three-star rating, which denotes the highest category of quality, covers the latest analysis of data from January 2019 to December 2019.
Coronary Artery Bypass Graft Treatment Overview
Coronary arteries are the blood vessels that nourish the heart muscle with oxygenated blood. Coronary artery disease (CAD) can cause a fatty buildup (plaque) to form in your heart arteries. The plaque narrows the vessels, restricting how much blood reaches the heart.
In some cases, the plaque completely blocks the vessel, cutting off all blood flow and causing a heart attack. CABG is an open-heart surgical procedure that diverts blood around blocked blood vessels to help improve heart function.
CABG Procedure Details
Your cardiac anesthesiologist puts you to sleep so you are comfortable throughout the surgery. Your cardiac surgeon then:
- Creates a graft by removing a healthy artery from your chest, arm or leg.
- Makes an incision down the center of your chest through the breastbone (sternotomy). This provides great visualization and access to the heart and coronary arteries.
- Stops the heart using special medicines.
- Connects a heart-lung bypass machine (cardiopulmonary bypass) that takes over heart and lung function throughout the operation.
- Sews the graft around a tiny opening made below the blockage in the damaged artery and connects it to an opening made in the aorta.
- Stops the heart-lung machine so your heart begins to beat and pump blood throughout the body.
- Closes the incision and prepares you for recovery.
Beating Heart Surgery
For many patients, Penn's cardiac surgeons can perform surgery on a beating heart, which is challenging. With this approach, we can remove a patient's breathing tube (extubation) before they leave the operating room. This minimizes the risk of pneumonia or other respiratory problems. Penn is now at an 80 percent extubation rate after CABG.
Off-Pump CABG
If you are at risk for complications from the use of a heart-lung machine, your surgeon may elect to perform off-pump CABG. This approach maintains the patient's body temperature and decreases bleeding. Our surgeons perform many CABG procedures without the use of a heart-lung machine.
Minimally Invasive CABG Surgery
Penn is a leader in developing and using new technology to improve heart surgery. Whenever possible, we use minimally invasive heart surgery to improve your experience and results. We often perform minimally invasive direct CABG (MIDCAB) with robot assistance. The benefits of MIDCAB surgery include:
- Reduced pain after surgery
- Lower risk of infection
- Less scarring
- Improved rate of recovery
Hybrid Coronary Revascularization
Some people may have blockages that require bypass surgery as well as blockages that may be opened with stents. Thanks to a strong partnership between cardiac surgeons and interventional cardiologists, many patients at Penn only need to undergo one operation to get complete care.
With hybrid coronary revascularization, our interventionalists and surgeons collaborate in a hybrid operating room. This state-of-the-art facility can be used for both traditional CABG surgery and catheterization procedures. Here, your team performs MIDCAB on some arteries and catheter-based angioplasty on others.
Cardiac Rehabilitation After CABG
After CABG, you will recover in the hospital for up to one week. To help recover your strength and stamina, your cardiac surgeon may recommend cardiac rehabilitation. Our cardiac rehab specialists provide gentle exercises and support in an outpatient facility.
After Open-Heart Surgery: Care for CAD
You may need additional support following a CABG procedure to ensure your other arteries remain unaffected by coronary artery disease. The physicians, nurses and dietitians of the Penn Primary Cardiology Program offer world-class preventive heart care. Our offerings include risk assessments, sophisticated imaging and specialized treatment for lipid disorders.