coronary artery bypass graft (CABG) surgery works very well to improve blood flow to the heart. But the procedure is very
invasive to your body for two major reasons.
It involves making a large cut in your chest to
expose your heart and arteries.
It requires stopping your heart and
connecting you to a heart-lung bypass machine. The machine takes over the work of your
heart and lungs.
Because it is so invasive, the procedure can cause
several complications. Surgeons have devised several new methods that
are less invasive and have fewer risks. But minimally invasive CABG surgery is not available everywhere. And this surgery is not right for everyone.
Beating-heart surgery is different from the standard CABG surgery. During a standard CABG procedure, your heart will be stopped and you
will be connected to a heart-lung bypass machine. Beating-heart surgery (BHS)
is unique. That's because the procedure is performed while your heart is still beating. You don't need the heart-lung bypass
There are two main types of beating-heart surgery (BHS). (Both are types of minimally invasive CABG surgery.)
Minimally invasive direct coronary artery bypass
Off-pump coronary artery bypass (OPCAB)
differs from traditional CABG surgery in two ways. First, MIDCAB does not use the heart-lung bypass machine. Second, your surgeon will cut
several small incisions in your chest to access your coronary
arteries. These small cuts are called thoracotomies. They are used instead of the one large incision (sternotomy) used in traditional
CABG surgery. These smaller cuts expose only the sections of your arteries
that require grafts. They don't expose your whole heart. This means you have a lower risk of infection. You also do not have a large scar like you would have with traditional CABG surgery.
The main disadvantage of MIDCAB is that it can't be used to treat
several diseased vessels. This is especially true if arteries on both the left and right
sides of the heart are affected. The limited number of small incisions made
using MIDCAB makes it hard to treat more than two coronary arteries during
the same surgery.
The off-pump coronary artery bypass (OPCAB) technique is another type
of beating-heart surgery. It requires one large incision. like traditional
CABG surgery. But with OPCAB, you don't need a heart-lung bypass machine. And this surgery may
not require manipulation of the aorta.
Is this surgery right for you?
You and your doctor can discuss whether minimally invasive CABG
surgery is a good choice for you. The decision depends on your overall health,
how bad your coronary artery disease is, how many bypasses need to be
created, and some other things. If you choose to have the surgery, it is
important to ask how experienced your cardiac surgeon is in doing these types
There are pros and cons to the various types of
minimally invasive CABG surgeries. With information and communication, you and
your doctor can make the right decision about which CABG procedure is best
Hillis LD, et al. 2011 ACCF/AHA Guideline for coronary artery bypass graft surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 124(23): e652–e735.
Sabik JF, et al. (2011). Coronary bypass surgery. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 1490–1503. New York: McGraw-Hill.
ByHealthwise Staff Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology Specialist Medical ReviewerRobert A. Kloner, MD, PhD - Cardiology
How this information was developed to help you make better health decisions.