What is Coronary Bypass Surgery?
Coronary artery bypass surgery began in the late 1950s. Bypass surgery is a procedure performed for certain types of coronary artery blockages. The procedure allows the surgeon access the heart and the diseased arteries through an incision in the middle or side of the chest. The purpose of bypass surgery is to increase the circulation and nourishment to the heart muscle.

With bypass surgery, arteries or veins are taken from other parts of the body to create the grafts that channel the needed blood flow to the coronary arteries. Removing them does not significantly affect the blood flow from where they are taken. The most common vein used for the bypass graft, the saphenous vein, is taken from the leg. The removal of this vein is performed as part of your bypass surgery. The most common artery used for the bypass graft is the internal mammary artery (IMA), located in the chest. At times, the radial artery, located in the arm, is used. The arteries or veins are connected directly to the coronary arteries on the surface of the heart beyond the blockages forming a graft.

This allows the blood to flow through them and bypass the narrowed or closed points.

The goal of any bypass surgery is to increase coronary artery blood flow. Increased blood flow will :

• Provide relief of angina (tightness in the chest).
• Improve the pumping ability of the heart muscle.
• Prevent heart attacks.
• Most importantly, the quality of your life will improve.

Different Techniques of Operations

• Traditional Bypass: With "traditional" by pass surgery, surgeons use the assistance of the heartlung machine along with medications to stop the heart so the bypass can be performed. The heart-Iung machine continues to provide blood flow the body needs to function while the surgeon repairs the heart. The heartlung machine is referred to as a "pump" because it continues to mechanically pump oxygen and nutrients to the body. 
• Beating Heart Surgery: Beating heart bypass surgery is different from traditional bypass surgery because it is performed while your heart continues to beat. During the procedure, your surgeon will not stop your heart or use the heart-Iung machine. In other words, your surgery will be performed "off-pump". Your surgeon will use instruments to stabilize a localized area of the heart where a bypass is being performed. This occurs while your heart continues to beat. allowing natural blood flow.
  This has become possible due to use of mechanical stabiliser devices like octopus, which holds and immobiliser that portion of heart where operation is being performed. The heart can be moved around easily without any hemodynamic instability. Usually along with these stabilisers, shunts are also used to maintain blood flow in Coronary Vessels. While your surgeon stitches new graft conduit on coronary vessel.
  This technique is becoming popular with heart surgeons, but there are many deciding factors which are to be considered by your surgeon whether case is suitable for this technique or not. Best technique will be decided upon after discussion with you and your treating physician and surgeon.
  In some cases, the surgeon may need to use the heart-Iung machine. In that event, a perfusionist (a specialist trained to operate the heart-Iung machine) is on standby during the procedure.
  The length of the operation varies according to the number of bypass grafts required. It can take anywhere from 2 to 6 hour. You surgeon will be able to provide you with a better estimate based on your selected treatment. 
• Arterial Type Coronary Artery Bypass Surgery: This is an advanced technique of coronary bypass surgery. In this, arteries such as internal mammary artery (which runs along your breast bone 'sternum' behind ribs) is used as conduit to bypass coronary artery block. There are two internal mammary arteries and they can be used in different ways to complete the procedure.
  Surgeon may also use other arteries like radial artery from arm or gastro -epiploic artery from abdomen for bypass grafting. These arterial conduits have better patency and rate in long term results.
• Port Access Coronary Bypass Surgery: New technological innovations like port-access coronary bypass surgery are also being developed and may soon be in hands of heart surgeons.
• Laser in Heart Surgery: Laser are being used to reopen the block to increase the blood flow in coronaries apart from this, a new technique called, trans myocardial revascularisation (TMR) by laser beams which create self-closing holes in heart muscle, is being used in selected cases. Again your cardiologist and surgeon will decide about best possible technique to increase the blood supply in the heart muscle where coronary arteries have blocks.