Watch: in my words
What is bypass surgery, and why do I recommend it?
Bypass or stents — and how the heart team decides
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Arteries versus veins
Almost every bypass uses the internal thoracic (mammary) artery from inside the chest wall for the most important blockage. The remaining blockages have traditionally been bypassed with a vein taken from the leg.
Arteries are built for high-pressure blood flow; leg veins were built for low-pressure return flow. In a Veterans Affairs cooperative study, 85% of internal mammary artery grafts were still open at 10 years, compared with 61% of vein grafts.
What “multiple arterial grafting” means
Multiple arterial grafting uses a second artery instead of leg veins for some of the other bypasses — the internal thoracic artery from the other side of the chest, or the radial artery from the forearm. It’s technically harder and takes longer in the operating room, which is one reason most programs don’t do it routinely.
More than 90%
of my bypass patients receive multiple arterial grafts when their anatomy allows
About 10–16%
of bypass operations nationally, 2008–2023 (STS database)
I start from the assumption that you deserve arterial grafts, and use vein only when there’s a clear medical reason.
What the evidence shows
In the largest look at this question — 172,007 bypass patients in the Society of Thoracic Surgeons national database, followed up to 15 years — the two main multiple-arterial strategies had similar long-term survival, and patients who received a third arterial graft had better adjusted survival than those with two.
- It is observational data; a randomized trial (ROMA) comparing multiple versus single arterial grafting is under way.
- Using both chest arteries carried a slightly higher rate of deep breastbone infection (1.1% vs 0.6%), so the right strategy depends on your age, diabetes, weight and lung health.
- Not every patient is a candidate. I’ll tell you which grafts I recommend for you, and why.
Our published bypass results
Our group at St. Luke’s holds the Society of Thoracic Surgeons’ highest rating — 3 stars, “better than expected” — for coronary bypass for January 2023 through December 2025, across all four measures STS reports: survival, freedom from major complications, use of the internal mammary artery, and the right medicines around surgery. See the public report.
Sources for this section: Goldman et al., J Am Coll Cardiol 2004 (VA Cooperative Study) · STS Adult Cardiac Surgery Database analysis, 2026 (TCTMD) · STS public report — our group at St. Luke’s
Common questions
What does “triple” or “quadruple” bypass mean?
It’s the number of grafts. Each blocked artery that needs a bypass gets its own graft, so a triple bypass has three and a quadruple has four. The number reflects your anatomy, not how sick you are.
Where do the grafts come from?
From your chest wall (the internal mammary arteries), your forearm (the radial artery) or your leg (the saphenous vein). I favor arteries whenever your anatomy allows, because they stay open longer.
Source: Ochsner Health — What is CABG surgery? · Goldman et al., J Am Coll Cardiol 2004 (VA Cooperative Study)
How long do grafts last, and how can I make them last?
Many grafts last 10 to 15 years or longer, and arterial grafts outlast vein grafts. You protect them by not smoking, taking your prescribed medicines, keeping blood pressure, cholesterol and diabetes controlled, eating a heart-healthy diet and staying active.
Source: Ochsner Health — What is CABG surgery? · Goldman et al., J Am Coll Cardiol 2004 (VA Cooperative Study)
Should I have bypass or stents?
It depends on how many arteries are blocked and where. In one study of patients under 50 presented to the Society of Thoracic Surgeons, those with blockages in all three main arteries did better over five years with bypass, while results were similar for one- or two-vessel disease. That’s why a heart team — surgeon and cardiologist together — should review your case.
Source: Society of Thoracic Surgeons — bypass vs. stents in patients under 50 (2018)
What are the main risks?
Infection, bleeding, irregular heart rhythms, kidney or liver problems, and stroke or heart attack. Your individual risk depends on your age and health; we calculate it with you before surgery. You can also review our program’s published, risk-adjusted results.
Source: Ochsner Health — What is CABG surgery? · STS public report — our group at St. Luke’s
What is recovery like, including the leg or arm incision?
Most patients spend about four to six days in the hospital, starting in the ICU, and full recovery often takes six to 12 weeks. If a vein was taken from your leg, some leg swelling is common while it heals.
Source: Ochsner Health — What is CABG surgery? · American Heart Association — How can I recover from heart surgery?
When can I drive, lift and go back to work?
General guidance from the American Heart Association after heart surgery: no driving for six weeks (riding as a passenger is fine — stop to walk every two hours), no lifting, pushing or pulling more than 10 pounds for six weeks, and light work in about six to 12 weeks. Sex can usually resume once you feel comfortable, often two to four weeks after leaving the hospital.
When I close your breastbone with rigid plates, I release you from sternal precautions at 6 weeks. Your own plan depends on your operation, so we go over it before you leave.
Source: American Heart Association — How can I recover from heart surgery?
Sources
- Ochsner Health — What is CABG surgery?
- Goldman et al., J Am Coll Cardiol 2004 (VA Cooperative Study)
- STS Adult Cardiac Surgery Database analysis, 2026 (TCTMD)
- STS public report — our group at St. Luke’s
- Society of Thoracic Surgeons — bypass vs. stents in patients under 50 (2018)
- American Heart Association — How can I recover from heart surgery?
