Coronary artery bypass graft (CABG)

Coronary artery bypass graft, or CABG, is a cardiac surgical procedure often performed to treat coronary artery disease. The surgery is used to divert blood around blocked blood vessels to help improve blood flow and heart function.

Coronary arteries are the blood vessels that nourish the heart muscle with oxygenated blood. Coronary artery disease 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.

Eligibility for coronary artery bypass graft is determined by a few factors, including:

• Current state of your cardiovascular system
• Severity of coronary artery disease (CAD) symptoms
• Location of plaque buildup related to CAD
• Results of cardiovascular medical tests and “stress tests”

Patients with mild symptoms of CAD are often treated with lifestyle changes, medication, or less invasive procedures like angioplasty. If these options have been ineffective, CABG is a likely option.

This surgery may also be performed in emergencies in which a heart attack may occur.

Traditionally, coronary bypass grafts are performed as open-heart surgery, which allows cardiac surgeons access to the entire heart through a large incision in your chest. During this type of surgery, the heart is stopped.

However, in recent years, minimally invasive techniques to bypass blocked or diseased coronary arteries have been developed. Minimally invasive heart surgery for coronary arteries usually involves smaller incisions (keyhole surgery), robotic-assisted surgery, or “off pump” surgery (in which the heart does not need to be stopped.

Open-heart CABG is still very common and often preferred in certain cases.

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.

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.

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 Penn Primary Cardiology offer world-class preventive heart care. Our offerings include risk assessments, sophisticated imaging and specialized treatment for lipid disorders.

Penn Medicine’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:

• 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.
• 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 analysis of data from January 2019 to December 2021.