The CABG Procedure

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At UW Health Heart and Vascular Care in Madison, Wisconsin, there are two ways the coronary artery bypass graft surgery (CABG) operation can be performed:
  • On-Pump
    In this type of operation, the heart is stopped and a machine does the job of the heart and lungs during the operation
  • Off-Pump
    In an off-pump operation, the heart continues to beat on its own throughout surgery
The decision whether to perform the operation on-pump or off-pump is made on a case-by-case basis. Considerations include heart anatomy, other coexisting illnesses and patient age.
On-pump and off-pump CABG procedures take about four to six hours. You will be asleep during surgery.
First, an anesthesiologist inserts a breathing tube into your trachea (the airway from your mouth to your lungs). This tube will help you breathe during surgery. Then, the surgeon makes an incision in the front of the chest and opens the breastbone.
The surgeon then takes one or more segments of healthy artery or vein from either the chest, the arm, the leg or the abdomen. These blood vessels will be used as conduits to redirect the blood supply to the heart.
Minimally Invasive Techniques
If a blood vessel from the leg is used, the surgeon can use minimally invasive techniques to remove the segment. To do this, the surgeon makes a small incision in the leg, inserts a small tube (a catheter) into the incision, and removes the vein through the tube.
Removing the leg vein segment in this manner results in fewer complications, a lower risk of infection after surgery, and faster healing time than if the vein were removed through a large incision. This is especially beneficial for patients with diabetes or peripheral artery disease.
Once the surgeon has selected the appropriate conduit, the heart is exposed. The surgeon then attaches the new blood vessel to the coronary artery below the blocked area, thereby redirecting the blood flow. If more than one artery is blocked, the surgeon repeats this for each blockage.
After each of the blockages are bypassed, the surgeon makes sure that there are no leaks where the grafts were attached. The surgeon then inserts a tube in the chest to help drain fluids, and closes the breastbone and chest incision.