Surgery for Coronary Artery Disease

This surgery bypasses blockages in the coronary arteries using a graft to create a new channel for blood to flow to the heart. Our surgeons typically use multiple arterial grafts for coronary bypass surgery, which is the most common procedure to treat coronary artery disease. Using arteries results in bypasses that are more resilient and last longer than those that use veins. At NYU Langone, more than 70 percent of people receiving multiple bypasses use more complex but durable arterial grafts, compared to a national average of 15 percent.

Your cardiac team decides whether percutaneous coronary intervention with stenting or coronary artery bypass surgery is best for you. Large clinical trials have shown that certain groups of people have significantly improved long-term results after coronary artery bypass surgery.

Using general anesthesia, the doctor performs a sternotomy, making an incision in the center of the chest and opening the breastbone. They then place plastic tubes in the heart’s right atrium, where blood enters the organ. These tubes channel blood into a heart–lung machine, which does the work of the heart and lungs during the surgery.

A coronary artery bypass can take up to four hours to complete. You can expect to remain in the intensive care unit for one to two days after surgery. Your doctor monitors you for signs of internal bleeding and arrhythmias, which are heart rhythm disorders. The typical hospital stay lasts five to six days.

During your recovery, your doctor may recommend avoiding driving for up to 3 weeks and lifting anything heavier than 10 pounds for 3 to 4 weeks. Total recovery time is usually four to six weeks.

Temporary Ventricular Assist Device with Coronary Artery Bypass

For people with advanced heart failure whose hearts are working at 35 percent capacity or less, NYU Langone cardiac surgeons use a unique technique that relies on a temporary ventricular assist device during bypass surgery. This method is most often recommended for people who have been told they are not candidates for heart surgery due to the extent of their heart failure.

During this surgery, the bypass is followed by a procedure to place a temporary ventricular assist device that takes over the pumping activity of the heart for up to 30 days. This gives the heart time to recover from the bypass and restore function. Because the pump is temporary, it can be removed at the bedside. This procedure relieves the symptoms of heart failure and helps people delay a heart transplant if that is the only other treatment option.

For some people who require a single bypass, a surgical robot can help the doctor perform a coronary artery bypass. It makes small, precise incisions and uses a camera that provides 3D, high-definition views of the arteries. The doctor controls the robot’s arm with a computer.

The robotic approach enables the surgeon to perform an endoscopic coronary bypass, which involves making four to five incisions in the chest, each less than an inch in size. The chest is not opened during the procedure.

Because the breastbone isn’t opened and the heart isn’t stopped, this procedure requires a shorter hospital stay—typically one to three days. Recovery takes approximately two weeks.

If you have a blockage that affects the left anterior descending coronary artery, your doctor may recommend this procedure, which is a combination of robotic-assisted bypass surgery and percutaneous coronary intervention to place a stent that opens the arteries.

The left anterior descending coronary artery carries blood to the left ventricle, the lower-left chamber of the heart. The left ventricle pumps blood to the aorta, the body’s largest artery, which carries oxygen-rich blood to the body.

In a hybrid revascularization, small incisions are made between the ribs. The thoracic artery, which supplies blood to the chest muscles, is used to bypass the left anterior descending coronary artery. Next, the doctor inserts a stent made of metal mesh into the blocked arteries to prevent them from narrowing. Our surgeons perform the bypass surgery first and the angioplasty three days later.

You can go home the day after the angioplasty. The total hospital stay is about five days, and recovery takes approximately two weeks.