General and Consultative Heart Care
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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 Duke Heart Center has a 98 percent success rate, despite the complexity of many cases. As a large teaching institution, Duke has the unique resources to perform a full range of cardiothoracic surgeries, from relatively simple to highly complicated.

We offer one of the nation's most experienced open-heart surgery programs and perform one of the country's highest volumes of cardiothoracic surgeries. Our robust research program means that Duke Heart Center offers the most sophisticated treatments available -- and gives patients the opportunity to participate in a number of clinical trials.

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).

Duke Heart Center's team of skilled cardiothoracic surgeons have performed coronary bypass grafting on more than 20,000 patients, with excellent outcomes. Not all CABG surgery is invasive; our minimally invasive CABG techniques include:

  • Off-pump CABG. Performed 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
  • Port-access CABG (“keyhole surgery”). Performed with a heart-lung bypass machine through small ports or incisions
  • Hybrid procedure. A combination of minimally invasive surgery and coronary angioplasty
  • Minimally invasive direct coronary artery bypass (MIDCAB). Performed on a beating heart through small ports or incisions
  • Robotic CABG. Beating-heart surgery performed endoscopically with a surgical robot

While these techniques hold great promise, they are currently used in only a select number of Duke's heart surgeries because of the advantages and disadvantages of each technique.

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.

Harvesting of Coronary Artery Bypass Conduits

In addition, 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 harvested vessels are used in bypass surgery.

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.

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About This Page

Published: Feb. 21, 2007
Updated: Nov. 4, 2009
URL: http://www.dukehealth.org/services/general_consultative_heart_care/treatments/surgery