Coronary artery surgery is done to restore blood flow to the heart when an artery leading to the heart muscle is blocked. The doctor takes a healthy artery from the leg, arm, chest or abdomen, connecting it to other arteries in the heart, bypassing the blocked area. This allows blood to flow freely to the heart muscle again. This can be done a number of ways using a variety of procedures.
Traditional Method
During traditional coronary bypass surgery, which is performed under general anaesthesia, the doctor stops the heart and a cardiopulmonary bypass machine--also known as a lung machine--takes over the work of the heart and lungs so the surgeon can perform the surgery on a still heart, according to the Mayo Clinic. This method also allows blood circulation to continue throughout the body while the doctor is performing the procedure.
Minimally Invasive Surgery
Minimally invasive surgery allows for a smaller incision and smaller scars. The doctor makes the incision on the side of the chest, and this incision tends to heal quicker, causing less discomfort for the patient than traditional surgery, as the Mayo Clinic explains. The Cleveland Clinic adds that patients tend to have a shorter hospital stay as well. Doctors perform a number of minimally invasive bypass surgeries which include robot-assisted, port-access robot-assisted and hybrid procedures.
Robot-assisted surgeries use a robotic system to see a magnified version of the heart's anatomy on a video monitor. The surgeon is able to perform a more precise surgery using this procedure.
A port-access robot-assisted minimally invasive coronary artery bypass surgery is similar to the robot-assisted procedure. The port-access comes from two small incisions made between the ribs. The surgeon inserts a long, thin tube with a high-definition camera attached to it. He then uses small instruments to perform the procedure.
Hybrid surgery is an option if a person is a candidate for both bypass surgery and an angioplasty--a procedure using a stent to unblock the arteries. A person must be a candidate for both because while one surgeon is performing bypass surgery, another is inserting stents in other arteries as a preventative measure against future blockages.
Basic Surgical Procedure
During a basic surgical procedure, the surgeon makes an incision slightly below the blockage. He then connects one end of the graft to the coronary artery and the other to the aorta. This connection then redirects the flow of blood around the blockage. The surgeon repeats this process for each individual blockage. Once the surgery is complete, the surgeon installs a chest tube to drain excess fluid, ensuring that it does not remain inside the chest or lungs. He then closes the sternum with stronger sternal wires and uses either internal or external sutures to close the chest around the sternum.
Off-Pump
The Cleveland Clinic explains that off-pump coronary bypass surgery differs from traditional surgery because the doctor chooses to rely on technological advances and operating equipment to stabilize the heart rather than stop the heart from beating completely during surgery. With this procedure he stabilizes one area of the heart as he unblocks the arteries in another area. This type of surgery lets the heart continue to pump blood throughout the body naturally. Not all patients are candidates for this procedure, and the surgeon makes his decision when he examines their heart and arteries more closely.
