Understanding Off-Pump Coronary Artery Bypass (CABG) Surgery
Coronary artery bypass surgery is a type of heart surgery. It’s often called CABG. The surgery is done to bypass a blocked area in one or more coronary arteries. This is known as coronary artery disease. The coronary arteries are blood vessels that bring blood and oxygen to the heart muscle. A healthy heart muscle pumps blood around the body.
What is off-pump CABG?
Off-pump heart surgery is done without using a heart-lung machine (called cardiopulmonary bypass). The heart instead keeps pumping blood on its own during the surgery. This is also known as “beating heart surgery.”
During CABG, a surgeon takes an artery or a vein from another place in your body. This blood vessel is known as the graft. It's then attached above and below the blocked area of the coronary artery. This lets blood bypass the blocked area. It restores normal blood flow to the heart. Your health care provider may plan the surgery in advance. Or you might need it in an emergency if a vessel suddenly becomes blocked.
Why off-pump CABG is done
The surgery can help ease chest pain and reduce the risk of a heart attack.
How off-pump CABG is done
Your procedure will be done by a cardiac surgeon. This is a provider who treats diseases of the heart. The surgery can be done in more than one way.
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You’ll be given medicine to prevent pain. It will also put you to sleep during the surgery (general anesthesia). Your breathing and vital signs will be watched during the surgery. You will also get blood-thinning medicine.
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Your surgeon will make a cut (incision) to remove a blood vessel from another part of your body. This is the graft. The graft is most often taken from your chest wall or your leg.
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Your surgeon will make an incision down the middle of your chest. They will then separate your breastbone to reach your heart.
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A device is placed on the heart to help keep the area being grafted stable. Your surgeon will attach one end of the graft to the diseased coronary artery beyond the blockage. This bypasses the blockage. The other end of the graft will be attached (stitched) to the aorta. This restores a flow of blood from the aorta through the graft to the heart muscle. The aorta is the main blood vessel leading from the heart out to the body.
Risks of off-pump CABG
All surgery has some risks. The risks of off-pump CABG include:
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Infection.
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Bleeding.
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Irregular heart rhythms.
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Blood clots that can lead to stroke or heart attack.
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Problems from anesthesia.
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Kidney failure.
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Need for a procedure in the future to improve the heart’s blood supply.
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Heart attack.
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Grafts that don’t work correctly.
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Death.
Your risks may vary according to your age, general health, and other things. Talk with your provider about which risks apply most to you.
Online Medical Reviewer:
Mary Mancini MD
Online Medical Reviewer:
Stacey Wojcik MBA BSN RN
Online Medical Reviewer:
Terri Koson DNP RN ACNP
Date Last Reviewed:
4/1/2025
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