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Heart Disease Health Center

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Heart Disease and Coronary Artery Bypass Surgery

How Is Traditional Heart Bypass Surgery Performed?

During traditional heart bypass surgery, a surgeon makes an incision (about 6 to 8 inches) down the center of your sternum (breastbone) to get direct access to your heart. You are connected to a heart-lung bypass machine (called "on-pump" surgery), which allows for circulation of blood throughout your body during surgery. The heart is stopped and the surgeon then performs the bypass procedure described above.

After surgery, the surgeon closes the breastbone with special sternal wires and the chest with special internal or traditional external stitches.

What Is Off-Pump Heart Bypass Surgery?

"Off-pump" or beating heart bypass surgery allows surgeons to perform surgery while the heart 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. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body.

With present technology, all coronary arteries can be bypassed off-pump. The off-pump technique may be ideal for certain patients who have an increased risk of complications from being placed on the heart-lung machine, such as those who have vascular disease, heavy plaque buildup in the aorta (aortic calcification), carotid artery stenosis (narrowing or blockage in the arteries leading to the brain), prior stroke or transient ischemic attacks (TIAs), or breathing or kidney function problems.

Not all patients are candidates for off-pump surgery. According to the American Heart Association, about 20% of heart bypass surgeries are performed off-pump. The decision to use off-pump surgery is made at the time of surgery when the patient's heart and arteries can be evaluated more closely.

What Is Minimally Invasive Heart Bypass Surgery?

During minimally invasive heart bypass surgery, the surgeon performs the surgery through a small incision (about 3 inches) in the chest. It may be an option for some patients who require a left internal mammary artery graft to the left anterior descending artery.

Some patients are also candidates for surgery using robotic-assisted techniques, allowing surgeons to perform bypass surgery in a closed chest, beating-heart environment through even smaller incisions.

The benefits of minimally invasive bypass surgery include:

  • A smaller incision, thus a smaller scar
  • A shorter hospital stay; in some cases, only three days are needed (instead of the average five to six days for traditional surgery).
  • Shorter recovery time

Other benefits may include:

  • Less bleeding
  • Less potential for infection
  • Less pain and trauma

Talk to your doctor to see if minimally invasive bypass surgery is right for you.

WebMD Medical Reference

Reviewed by James Beckerman, MD, FACC on May 16, 2014
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