During traditional CABG, a surgeon will make an incision down the center of your sternum (breastbone), to get direct access to your heart. You are connected to the heart-lung bypass machine which allows the circulation of blood throughout the body during surgery. The heart is stopped and the surgeon then performs the bypass procedure. After surgery, the surgeon closes the breastbone with special sternal wires and the chest with special internal or traditional external stitchs.

Your surgeon will review your diagnostic tests prior to your surgery to see if you are a candidate for minimally invasive bypass surgery.

Minimally invasive bypass surgery can be performed through a small thoracotomy incision for patients that require a LIMA graft to the LAD.

Newer robotic techniques are allowing surgeons to perform bypass surgery through even smaller keyhole incisions.

The benefits to minimally invasive bypass surgery include:

• smaller incision - smaller scar
• shorter hospital stay - in some cases, only 3 days are needed (instead of the average 5 - 6 days for traditional surgery)

Other benefits may include:

• shorter recovery time
• less bleeding
• less potential for infection
• less pain and trauma

Off-pump or beating heart bypass surgery

Off-pump or beating heart bypass surgery allows surgeons to perform surgery on the heart while it is still beating. The heart-lung machine is not used. The surgeon uses advanced operating equipment to stabilize (hold) portions of the heart and bypass the blocked artery in a highly controlled operative environment. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body.

Bypass Grafts

There are several types of bypass grafts that can be used. These types of blood vessels can be used because there are other pathways that take blood to and from the tissues of your chest, arms, and legs. The surgeon decides which graft(s) to use depending on the location of blockage, the amount of blockage, and the size of your coronary arteries.

Surgeons use arteries more than veins to bypass narrowed coronary arteries. This is done because the arteries do not close nearly as quickly after surgery as do the veins, which have traditionally been used to bypass arteries of the heart.

After Surgery

If the procedure was done "on pump," electric shocks start the heart pumping again after the grafts have been completed. The heart-lung machine is turned off and the blood slowly returns to normal. Pacing wires and a chest tube to drain fluid are placed before the sternum is closed surgically with special sternal wires and the chest with special internal or traditional external stitches. Sometimes a temporary pacemaker is attached to the pacing wires to regulate the heart rhythm until your condition improves.

The patient is transferred to an intensive care unit for close monitoring for about one to two days after the surgery. The monitoring during recovery includes frequent checks of vital signs and other parameters, such as heart sounds and oxygen and carbon dioxide levels in arterial blood.

Once the patient is transferred to the nursing unit, the hospital stay is about 3 to 5 more days.

Recovery

Full recovery from coronary artery bypass graft surgery takes two to three months. Most patients are able to drive in about three to eight weeks after surgery. Sexual activity can be resumed in three to four weeks, depending on your rate of recovery. Most people with sedentary jobs can go back to work in four to six weeks after surgery; people with more physical jobs (such as construction workers or jobs requiring heavy lifting) may have to wait up to twelve weeks before returning to work. Your doctor will provide specific guidelines for your recovery and return to work, including specific instructions on how to care for your incision and general health after the surgery.