Clinical Indications
Surgeons typically recommend CABG when less invasive procedures, like angioplasty or stenting, are insufficient or risky. Common indications include:
Left Main Disease: Blockages greater than 50% in the left main coronary artery, which supplies the majority of blood to the heart.
Triple-Vessel Disease: Significant narrowing in all three of the heart's major arteries.
Failed Prior Interventions: Recurrent blockages after previous stenting or when a stent cannot be safely placed.
Complex Anatomy: Blockages located in difficult-to-reach areas or "chronic total occlusions."
Surgical Methodologies
There are three primary ways the surgery is performed in 2026:
On-Pump (Conventional): The chest is opened via a sternotomy, the heart is temporarily stopped, and a heart-lung bypass machine takes over the circulation of blood and oxygen.
Off-Pump (Beating Heart): The surgeon operates while the heart is still beating, using specialized stabilizers to keep the work area still. This avoids the inflammatory response sometimes caused by the bypass machine.
Minimally Invasive (Robotic-Assisted): Utilizing "keyhole" incisions between the ribs, surgeons use robotic platforms to perform the bypass without dividing the breastbone. This leads to significantly faster recovery times.