Coronary artery bypass grafting (CABG) which is also known as heart bypass surgery is a surgical procedure that improves the blood supply to the heart. It is used in the treatment of coronary arterial disease which results in the narrowing and blockage of the arteries that supply the heart. The surgery involves taking healthy blood vessels from the chest, arm or leg in order to create these new paths of blood around blocked or partially blocked arteries, resulting in improvement in symptoms such as chest pain and shortness of breathe.

In the past, taking just one arterial blood vessel from the left chest was the gold standard in CABG surgery but new research has shown using more than one arterial graft has better long term outcomes. Specifically using both the left and right internal thoracic arteries from the chest, and in some cases the radial artery from the forearm results better durability and patency and is believed to play a key role in patients living longer compared to just a single arterial graft.

Percutaneous coronary intervention (PCI) is a less invasive alternative of treating coronary artery disease with quicker recovery times. In certain patients who are high risk, it can be the only option for dealing with the blockage that exist in the coronary arteries. In situations where PCI or CABG is feasible, studies have shown that PCI is less durable which results in more interventions when the stents themselves develop disease, as well as worse survival over time.

If only one or two coronary arteries are narrowed or blocked, then a less invasive surgery can be performed. Minimally invasive direct coronary artery bypass (MIDCAB) is a type of CABG surgery that is done without the conventional open chest approach but rather a smaller incision to bypass certain blocked for narrowed coronary arteries. Robotic surgery is used to help harvest internal thoracic artery and subsequently a small incision along the chest wall is made to facilitate bypassing the blocked or narrowed blood vessel. The advantages of this approach is less time in recovery since a full sternotomy is not required which is needed in standard CABG operations.

It is important to have a discussion with both your surgeon as well as your cardiologist in order to help make the best decision for you and your family. Each patient is different, and at the center of each medical decision is you, the patient.