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Surgery in coronary heart disease is reserved for people whose disease is either severe or is not improved or stabilized by medication and other less invasive therapies.

Coronary artery bypass grafting (CABG): This is the standard operation for blockages of coronary arteries.

• If multiple coronary arteries are blocked, or if the left main artery shows significant blockage, bypass surgery is usually the best treatment choice.
• The blocked parts of the arteries are detoured or bypassed with blood vessels "harvested" from your chest (internal mammary), arm (radial artery), or a leg (saphenous vein).
• During the surgery, the heart is stopped temporarily and you are connected to a machine called a bypass pump that takes over the functions of the heart.
• These operations are very successful and have a low rate of complications.

Off-pump bypass surgery: Sometimes surgeons can perform open heart surgery without using a bypass pump and while the heart is beating. The procedure causes fewer side effects than the standard procedure, but it is not feasible in all situations.

Minimally invasive coronary bypass (MINI-CABS): If just your front or right coronary arteries need bypass, a surgeon may replace the blocked artery with an artery from the chest via a small keyhole incision, without opening your chest, to detour the blockage.

Transmyocardial laser revascularization (TMR): TMR offers an alternative for people who are not good candidates for either angioplasty or bypass surgery.

• A surgeon uses a laser catheter to create multiple pinholes in your heart muscle.
• The holes encourage growth of new vessels into the diseased heart muscle.
• This procedure can be done by itself or in conjunction with coronary bypass surgery.

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