On-Pump and Off-Pump Coronary Artery Bypass Grafting

Surgery for coronary artery disease is known as coronary artery bypass grafting (CABG). It was one of the landmark operations in the history of cardiac surgery that rescued millions of people afflicted by coronary artery disease. It was first performed by Kolesov,1 was popularized by Favaloro,2 and is still the leading heart operation performed today.Current reasons for performing CABG are the presence of 3-vessel disease (all the 3 major arteries to the heart are blocked), left main coronary artery disease (the main artery itself is critically narrowed), and 3-vessel disease in diabetics. It also is used for patients with severely depressed heart function and for patients who need surgery for heart conditions in addition to coronary artery disease (such as replacement of valves or reconstruction of the heart muscle).Similar to a detour on a highway in the setting of a roadblock, CABG involves the strategic placement of bypass grafts that will provide an alternative route for the blood to flow around the blockage (Figure). These bypass grafts are composed of other arteries and veins from the body of the patient that are harvested only when they are numerous in their location or their function in their primary location can be safely and effectively taken over by …