Depending on the size, number, and location of an individual's atherosclerotic lesions, physicians often prefer surgery over angioplasty to increase blood flow to the heart. There is increasing scientific evidence that long-term outcome is indeed more favorable with surgery in many individuals.

Open-heart surgery has saved millions of lives, and has a 98 percent success rate at Duke. As a large teaching institution, Duke has the unique resources to perform a full range of cardiac surgeries, from relatively simple to highly complex.

We offer one of the nation's most experienced open-heart surgery programs -- our surgeons helped develop new techniques when cardiac operations were in their early stages, and we have performed coronary bypass grafting on more than 20,000 patients.

Coronary Artery Bypass Grafting (CABG)

More than 336,000 Americans annually undergo the most popular surgical procedure -- coronary artery bypass grafting (CABG) -- in which cardiac surgeons create a detour around a blocked artery by grafting an artery from the chest wall or arm, or a section of vein from a patient's leg, onto the artery of the heart (coronary artery).

Some patients will require repair or replacement of one or more of the heart valves, in addition to needing coronary artery bypass grafting. Visit DukeHealth.org’s Valvular Heart Disease section for more information.

Minimally Invasive Procedures

Harvesting of Coronary Artery Bypass Conduits

Many patients can benefit from endoscopic harvesting of veins or arteries for bypass. Almost 100 percent of the leg vein harvesting performed at Duke is done endoscopically, meaning physicians make tiny incisions and use video imaging to graft veins or arteries. The smaller incisions reduce discomfort and infection rates.

Radial artery harvesting -- which physicians sometimes use in certain situations -- can also be performed endoscopically.

Duke also has the capability to perform internal thoracic artery harvesting robotically.

Surgery

At Duke, properly selected patients undergo minimally invasive surgery such as off-pump coronary artery bypass surgery (OPCAB).

In OPCAB, in contrast to traditional CABG, surgeons do not stop the heart and use a heart-lung machine to continue cardiac and pulmonary function.

Instead, physicians operate through either a small midline incision through the breastbone or a four- to five-inch incision between the patient's ribs on a still-beating heart, with the artery to be bypassed held steady by gentle suction.

Other minimally invasive bypass procedures available for certain patients include minimally invasive direct coronary artery bypass (MIDCAB) and port-access coronary artery bypass (keyhole surgery), both of which involve smaller incisions.

While such minimally invasive techniques hold great promise, they are currently used in a select number of Duke's 1,300 heart surgeries each year because of the various advantages and disadvantages of each technique.

Physicians

Physicians offering this service include:

• Davis, R. Duane
• Glower, Donald D.
• Hughes, G. Chad
• Jaggers, James
• Lin, Shu S.
• Lodge, Andrew J.
• Lowe, James E.
• Lowry, Terry S.
• Milano, Carmelo A.
• Smith, Peter K.

Locations

This service is available at:

• Duke Cardiothoracic Surgery
  Duke Clinic 2B, 200 Trent Drive, Durham, NC 27710