Coronary Artery Surgery

Coronary artery bypass grafting (often called “CABG” or pronounced “cabbage”) is a type of open-heart surgery. Surgeons create a new pathway—or “bypass”—around blockages in the arteries that supply blood, oxygen, and nutrients to your heart muscle. This procedure aims to restore proper blood flow to the heart and help prevent heart attacks.

Over time, fatty deposits (plaque) can build up inside the coronary arteries, narrowing them and reducing blood flow. This can cause symptoms such as:

• Chest pain (angina pectoris)
• Heart attack (myocardial infarction), if blood flow is severely obstructed

In some people—especially those with diabetes—chest pain may be absent, and a “silent” heart attack could be the first warning sign.

Several factors can increase your chances of developing blocked arteries:

• Male sex (men often develop heart disease at a younger age)
• High blood cholesterol
• Diabetes mellitus
• High blood pressure (hypertension)
• Smoking
• Family history of early heart disease

If you have multiple risk factors or a strong family history, it’s important to see your doctor for an evaluation.

Your doctor may order:

1. Stress Test: You exercise on a treadmill or bike while your heart is monitored.
2. Cardiac Catheterization: A thin tube (catheter) is inserted into an artery (usually in your groin or arm) and guided to your heart. A contrast dye is injected, and X-rays show the exact location of any blockages.

CABG is typically suggested if:

• The left main coronary artery is significantly blocked
• All three major coronary arteries are blocked, especially if the left ventricle (main pumping chamber) is weakened
• Severe chest pain (angina) persists even with medications
• Other treatments (like balloon angioplasty) aren’t sufficient or possible

Your doctor will recommend CABG based on your unique medical history, test results, and overall heart function.

• Surgical Incision: A surgeon makes an incision down the center of your chest (median sternotomy) to access your heart.
• Heart-Lung Machine (Traditional Approach): You may be placed on a bypass machine that temporarily takes over the work of your heart and lungs so the surgeon can work on a still heart.
• Grafting:
  • Saphenous Vein Grafts (from the leg) are attached to the aorta and the coronary artery past the blockage.
  • Internal Thoracic (Mammary) Artery Grafts (from inside the chest wall) tend to stay open longer, so they are often used to improve long-term results.

• Multiple Arterial Grafts: Using more than one artery (instead of veins) to improve long-term success and reduce the chance of needing another bypass surgery.
• Off-Pump (Beating-Heart) Surgery: Bypass is performed while the heart is still beating, without using the heart-lung machine.
• Minimally Invasive Approaches: Smaller incisions may result in less pain and faster recovery.

At UCLA Health, our surgeons continually refine these advanced techniques to offer patients the most effective and least invasive options possible.

Like all major surgeries, CABG comes with some risks:

• Bleeding or infection
• Stroke (risk may be higher in older adults or those with prior stroke)
• Kidney problems (especially in patients with pre-existing kidney issues)
• Heart attack during or after the procedure

At UCLA Health, your doctors will carefully review your personal risk factors and discuss them with you before suggesting bypass surgery. They’ll only recommend this operation if they believe simpler treatments—like medications or balloon angioplasty—aren’t enough to keep you healthy.

CABG has an excellent track record for:

• Relieving Chest Pain: Many patients experience immediate relief.
• Improving Energy Levels: After recovery, patients often feel more energetic because their heart is receiving better blood flow.
• Longevity: Research shows that in certain groups of patients, CABG can help them live longer compared to other treatments.

Although some patients may need additional procedures years later, improvements in surgical techniques are reducing the need for repeat operations.

Yes. In some cases, doctors may try:

• Aggressive Medical Therapy: Adjusting medications for blood pressure, cholesterol, and other risk factors.
• Balloon Angioplasty and Stenting: A minimally invasive procedure to open narrowed arteries, if suitable.

Your UCLA Health cardiologist or surgeon can explain which options are best for you.

• Chest Discomfort: Some soreness at the incision site is common for a few days.
• Energy Levels: You may feel tired initially as your body recovers, but most people see an improvement in stamina once they heal.
• Returning to Normal Activities: With proper rest and possibly a cardiac rehabilitation program, most patients return to their usual daily routines or feel even better than before.