Coronary Artery Bypass Grafting

Coronary artery bypass grafting (CABG or coronary bypass) is a procedure in which surgeons create an alternate pathway (a grafted vessel taken from another part of the body) around blocked areas of coronary arteries to enable sufficient blood to reach the heart. Left untreated, such blockages result in inadequate supplies of oxygen and nutrients to the working heart, which may cause unstable angina (chest pain), or ultimately, the death of heart muscle (myocardial infarction, commonly known as a heart attack).

Traditionally, CABG is performed on a still heart, with a cardiopulmonary bypass machine supporting blood and oxygen flow to the rest of the body. Today, it can also be performed off pump, which means the blocked coronary artery is briefly occluded to perform the graft while the heart remains pumping, providing blood flow to the rest of the body and making the heart-lung machine unnecessary.

UNC has an expert team of heart and vascular specialists who collaborate on the diagnosis and treatment of every heart patient under our care. Cases that appear to benefit from coronary bypass include patients who have symptomatic heart disease in multiple coronary arteries, and those who have suffered a prior or acute myocardial infarction. The goal of CABG is to provide improved blood flow to all areas to the heart (complete myocardial revascularization).

Traditional or Off-Pump CABG?

UNC performs both traditional CABG procedures, and off-pump coronary bypass grafting (OPCABG). While each procedure has its advantages and disadvantages, it’s important that, as at UNC, a skilled team of specialists work together to determine which procedure is likely to provide the greatest quality- and length-of-life benefits.

The advantages of OPCABG appear to be fewer neurological, pulmonary, and renal complications. Although traditional CABG is performed nationally with a 2-3% mortality and average hospital length of stay of less than 7 days, retrospective studies suggest that off-pump CABG may be safer, with fewer procedure-related deaths and complications. OPCABG is associated with fewer blood transfusions, decreased ventilator dependence, less renal insufficiency, and fewer strokes.

Though research is not yet conclusive, indications are that older, frail patients who suffer from pulmonary insufficiency caused by chronic smoking, who’ve also had a prior stroke, mild dementia, and/or kidney problems may be better served with the beating heart strategy offered by OPCABG.

Off-pump coronary bypass requires an expert team of surgeons, anesthesiologists, nursing staff, and physician assistants, as well as specially designed stabilizing devices and impressively small shunts (passages that allow blood to move from one part of the heart to the other). Relying on the experience and proficiency of this team, UNC is able to perform beating-heart CABG in approximately one-third of our patients. Barring unforeseen complications, most such patients are able to return home within 4-7 days.


Andy C. Kiser, MD
Brett Sheridan, MD

Contact Us

Call the Heart & Vascular Center referral line at 866-862-4327 to find specialists, make an appointment or learn more about preventing heart disease.

Open Access is a new physician referral service, created by the UNC Center for Heart & Vascular Care, which coordinates all admissions and transfers through a single phone call and guarantees immediate acceptance for patients. Please contact us to learn more or call 866-862-4327.

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