Surgery to Treat Coronary Artery Disease

University Hospitals offers a number of different kinds of heart bypass surgery, including:

Minimally invasive coronary artery bypass graft (MIDCAB)

Small incisions are made in the chest, and chest arteries or veins from your leg are attached to the heart to bypass the clogged coronary artery or arteries. Surgical instruments are passed through the ports to perform the procedure. Avoids need for a heart-lung machine. The procedure is performed while the heart continues to beat.

Hybrid percutaneous coronary intervention (PCI) and coronary revascularization

Combines MIDCAB with percutaneous coronary intervention, a nonsurgical procedure to improve blood flow to the heart.

Total arterial revascularization

All coronary arteries are provided with arterial grafts.

Off-pump beating heart surgery

The operation is done with the heart beating and without the use of a heart-lung machine.

Frequently Asked Heart Surgery Questions

I need a new heart valve. What kind should I get?

There are many different valves that heart surgeons use to replace a valve that may be faulty. These include pig valves, cow valves, mechanical valves, or valves from another human being. The mechanical valve is good for younger patients because it'll last longer, but you will need to be on a blood thinner such as warfarin (Coumadin) for the rest of your life. The problem with tissue (pig, cow or human) valves is durability; they usually last 10 – 15 years and can sometimes last up to 20 – 25 years. However, you don’t need to be on a blood thinner with a tissue valve. It's an important discussion to have with your surgeon because there are pros and cons to each type of valve and it needs to fit your lifestyle and what's important to you.

How long does a heart valve replacement last?

It depends on what kind of valve your surgeon uses. There are two types of valves, mechanical and tissue. Mechanical valves tend to last for the rest of your life. It is very rare for them to break down. Tissue valves, however, do have a life expectancy on average of 12 to 15 years. The tissue valves tend to last a little bit longer in older patients because they may be less active, so there’s less wear and tear on the valve. In these cases, they may last 20 years or more. However, if you’re younger and still very physically active, the valve may wear out sooner. At that time, you can discuss with your surgeon your options for repair.

Can a heart valve be repaired instead of replaced?

Yes, but it depends on the type of valve and the disease state of that valve. There are two major valves that require heart surgery, the aortic valve and the mitral valve. The aortic valve typically becomes very calcified. The opening narrows and blood can’t flow through. That valve needs to be replaced either through transcatheter aortic valve replacement (TAVR), in which the valve is replaced through the groin, or through a standard aortic valve replacement, when replacement is done through an incision on your chest. The other valve that gets diseased is the mitral valve. This valve tends to leak but it doesn't get blocked like the aortic valve. Typically, 90 to 95 percent of those valves can be repaired. Talk to your cardiac surgeon or cardiologist to find out whether your valve can be repaired or replaced.

When can I resume normal activities after heart surgery?

It depends on how well you’re recovering and on the type of operation that you've had. If you had a sternal incision on your chest, typically that bone needs to heal before you get behind the wheel of a car, so about 4 to 6 weeks. If it's a less invasive operation done through the ribs, you may only 2 to 3 weeks before you can drive again. For activities like golf, you can typically start swinging a golf club 2 to 3 months after surgery. For sexual activity, we typically ask you to wait a few weeks to make sure you’re feeling well and healthy enough and not putting yourself at risk. The typical period of rest before resuming most light activities such as gardening or household chores is 4 to 6 weeks. This allows time for the bone to heal and will be relatively safe for most patients.

What will happen if I delay or postpone open heart surgery?

There are usually two reasons that we recommend open heart surgery: to help you live longer or to help you have a better quality of life. If it's to help you live longer, it really depends on what the problem is. If you have a 90 percent blockage in the main artery of your heart, the data says you're unlikely to be alive within the next one to two years. If you delay surgery for a long time, you are increasing your risk of dying sooner. If your operation is to improve your quality of life, it may not affect your survival but it will impact the things that you're able to do and the enjoyment that you get out of life. In some cases, if you wait too long the disease may become more advanced, making the operation more difficult, putting you at higher risk and making recovery take longer. Before you delay any surgery, make sure that you have that conversation with your physician so you understand the risks of having the surgery versus the risks of delaying it.

What are the risks of open-heart surgery?

The risk of dying or having a stroke with open-heart surgery are relatively low, typically in the range of 1 to 3 percent for most patients. The majority of relatively healthy patients have a 1 percent or less risk of dying or having a stroke. Minor complications include things such as bleeding, infections, pneumonia, blood clots and atrial fibrillation, or an irregular heartbeat. All of these things are treatable through medications or other means. They are usually short term and will resolve with proper treatment.

Does coronary bypass surgery ever need to be redone?

Very few patients who undergo coronary bypass surgery will ever need to have it done again. The data show that less than 5 percent of patients who have coronary bypass surgery are going to need another open-heart surgery. The chances of you ever needing another heart operation are probably less than one in 20, especially as technology advances and we develop better techniques for fixing your heart.

Do I need open-heart surgery or can it be done minimally invasively?

This will depend on a lot of things, including what your condition is and what type of operation you need. There are two main types of operations, surgeries for coronary artery disease and surgeries for valvular disease. For most patients who need coronary bypass surgery, open-heart surgery is necessary. However, for some patients with only one or two blockages, surgery can be done minimally invasively through a small incision, usually on the left side between the fourth and the fifth ribs. Talk to your doctor about what you need and what the options are. It's also possible that your surgeon or your hospital does not offer minimally invasive surgery. In that case, you should ask to be referred to somebody who offers it. It's an important discussion to have to explore all your options.

Will I need an on-pump or off-pump heart surgery procedure?

Most of the time when patients have heart surgery, surgeons use a heart-lung machine or cardiopulmonary bypass. But there are some patients, especially those that need coronary bypass surgery, where the operation can be performed without the use of a heart-lung machine, or off-pump. In that type of procedure, the heart continues to beat throughout the procedure and the surgery team can use devices to immobilize certain parts of the heart. That way they don't have to stop the heart or the lungs during surgery. You can talk to your cardiac surgeon about whether off-pump surgery is appropriate for you.

Why not unblock the blockages of the heart?

We have not yet developed medications that will take those blockages away completely. Normally, you need a mechanical fix for those blockages. One way to do this is with a stent, a less invasive procedure in which a catheter in the arm or leg is used to insert a stent to pen the artery and allow blood to flow. The other option for patients with severe artery blockages is coronary bypass surgery.

Why can't my arteries be fixed with a stent or a balloon?

When patients come for coronary bypass surgery it's usually because stents are not feasible or are not the right thing to do. Usually when you're sent to a surgeon it's because you have too many blockages to stent, the blockages are too calcified, or they're in an area where they're splitting into two different directions, which makes it difficult to use a stent. It’s important to discuss your options with your cardiologist and your heart surgeon to help decide which procedure is right for you.

What is the success rate of a coronary artery bypass graft (CABG)?

Success is defined by your ability to go home healthy and resume a normal and active life. The success rate for each individual patient may be higher or lower based on the presence of other diseases such as obesity, diabetes, lung disease or kidney disease. In the U.S., the average rate of survival after coronary bypass surgery is around 98 percent.

What is a coronary artery bypass grafting (CABG)?

This is an operation that cardiac surgeons perform to unblock somebody's arteries. When somebody has blocked arteries on their heart, they often have different options for unblocking the arteries. With CABG, our cardiac surgeons take an artery from either inside your chest, from your arm, or a vein from your leg and connect it to blood vessels above and below a coronary artery. This bypasses the blockages that are not allowing enough blood flow to go to your heart. Some of the symptoms that you may experience are shortness of breath, tightness or pain in your chest or the feeling that somebody's pushing on your chest. When you have those types of symptoms and blockages are found, you may need an operation.

If a vein is taken from a leg for heart surgery, what replaces it?

We usually take an artery from the chest or from the arm, or a vein from the leg. Anytime we use one of those vessels, we do so because there's another vessel there that can take its place, making it somewhat redundant. Typically, when we take those veins, we use a very small incision. Most patients will never notice that that vein is missing once they recover.