Bypass surgery is a surgical procedure performed to relieve the symptoms of angina pectoris and reduce the risk of death from coronary artery disease. When one or more of the coronary arteries become partially or totally blocked, the heart does not get an adequate blood supply. This is called ischemic heart disease or coronary artery disease (CAD). It can cause chest pain (angina) and even lead to death.

In the bypass surgery arteries or veins from elsewhere in the patient's body grafted from the aorta to the coronary arteries to bypass atherosclerotic narrowing and improve the blood supply to the coronary circulation.

A patient may undergo one, two, three or more bypass grafts, depending on how many coronary arteries are blocked.

The surgeon reviews the coronary angiogram prior to surgery and identifies the lesions (or "blockages") in the coronary arteries. The surgeon then will estimate the number of bypass grafts prior to surgery, but the final decision is made in the operating room upon examination of the heart.

Generally during this procedure the patient is connected to the heart-lung machine, or bypass pump, which adds oxygen to the blood and allows its circulation in the body. This is necessary because the heart muscle must be stopped before the graft can be done.

One end of the graft is stitched to an opening below the blockage in the coronary artery, and its other end is stitched to an opening made in the aorta.

Recently alternate methods of minimally invasive coronary artery bypass surgery have been developed. Off-pump coronary artery bypass surgery (OPCAB) is a technique of performing bypass surgery without the use of the heart-lung machine. Minimally invasive direct coronary artery bypass surgery (MIDCAB) is a technique of performing bypass surgery through a 5 to 10 cm incision.

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