DR MILES DALBY

Coronary Artery Bypass Surgery (‘bypass’, ‘CABG’) is an open heart surgery operation which may be performed with a machine taking on the work of the heart and lungs (cardiopulmonary bypass) or with the heart still beating (‘off pump’ or ‘beating heart’). The operation can be performed through the breastbone (midline sternotomy) or sometimes through a smaller incision in the left chest (minimal access, midcab). These various techniques all have attendant benefits and limitations thus the approach must be tailored to the individual patient.

The bypass is performed using grafts (arteries and veins) to bypass the blood around narrowings of the coronary arteries to supply blood to the arteries beyond the narrowings. The Internal Mammary Arteries (from inside the chest)-usually the left (LIMA) are the best grafts and they usually remain unblocked (patent) for many years. Radial artery grafts (from the forearm) can also be effective grafts. Sections of veins (from the legs) are also effective. Most bypass operations use both arterial and venous grafts.