Coronary Artery Bypass Graft (CABG)
Coronary artery bypass is often recommended instead of angioplasty/stents
when stenting would be technically difficult or risky, when there are multiple blockages, and when arteries are already
100% occluded. Patients with diabetes and heart failure may especially benefit from bypass surgery, rather than stents.
Many randomized trials have compared surgery and angioplasty/stents for patients with coronary artery disease. These
studies have shown certain patient groups to do better with surgery. Patients who have surgery are less likely to have
additional angina or need further procedures than patients treated with stents. However, surgery is a major operation
and there are always risks involved. In addition, sometimes bypass grafts fail, or cannot cover all areas, and a combination
of surgery and stents are performed.
Bypass surgery involves taking a vein from the leg, an artery from the wrist, or an artery from
the chest wall to jump blood flow around the cholesterol blockages. This has traditionally been done with the assistance
of a heart-lung bypass machine in order to stop the beating heart.
A new technique, off-pump surgery, can now be performed. This technique is much more difficult, and requires a surgeon who practices it frequently in order to become skilled
and have good outcomes. In selected patients (such as those with calcified aortas) and with skilled surgeons, off-pump
bypass may offer benefits such as faster recovery and less neurologic (memory) problems. However, long-term outcomes
appear similar. The surgeons at St. Marks routinely perform
off-pump bypass surgery. These surgeons have also been recognized for exceptionally low complication rates and length
of hospital stay.
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