Coronary Artery Bypass Graft: Surgical Technique for Restoring Blood Flow in Advanced Heart Disease
Coronary Artery Bypass Grafting (CABG) is a life-saving surgical procedure used to redirect blood flow around blocked or narrowed coronary arteries to restore adequate oxygen supply to the heart muscle.
Coronary artery disease is primarily caused by atherosclerosis, a gradual buildup of plaque that leads to reduced blood flow and ischemia. When coronary arteries are severely obstructed, the heart becomes compromised, resulting in symptoms such as angina, fatigue, and shortness of breath, and in severe cases, myocardial infarction. CABG remains the gold-standard treatment in patients with multi-vessel coronary artery disease, left main coronary artery stenosis, diabetes mellitus with complex lesions, or cases where angioplasty has failed or is not suitable.
During CABG, surgeons harvest blood vessels—commonly the saphenous vein from the leg, radial artery from the arm, or internal mammary artery from the chest—and graft them to bypass blocked segments of coronary arteries. The left internal mammary artery is considered the most durable graft with superior long-term patency. Traditionally, CABG is performed using a sternotomy and cardiopulmonary bypass (“on-pump” CABG). However, advances have enabled “off-pump” beating-heart techniques, reducing complications like stroke and renal dysfunction in selected patients.
Modern progress includes minimally invasive direct coronary artery bypass (MIDCAB), robotic-assisted CABG (using systems like the Da Vinci robot), hybrid coronary revascularization combining CABG with coronary stenting, and enhanced postoperative cardiac rehabilitation. These innovations offer faster recovery, minimal scarring, and shorter hospital stays while maintaining surgical precision.
Despite its high success rate, CABG carries risks such as postoperative arrhythmias (especially atrial fibrillation), wound infection, bleeding, cognitive changes, and graft occlusion over time. Long-term success depends heavily on patient lifestyle modification, medication adherence, cardiac rehabilitation, and management of risk factors like hypertension, hyperlipidemia, diabetes, and smoking. CABG continues to evolve through improved grafting techniques, tissue-engineered vessels, imaging guidance, and artificial intelligence-enabled surgical planning, securing its role as a cornerstone in modern cardiovascular therapy.