Yes, coronary artery bypass grafting (CABG, pronounced “cabbage”) is the most common type of open heart surgery performed today. The traditional procedure requires opening the chest through the breastbone, stopping the heart, and using a heart-lung bypass machine while a surgeon reroutes blood flow around blocked coronary arteries. That said, newer variations of CABG use smaller incisions or skip the heart-lung machine entirely, which blurs the line for some patients.
What Makes Traditional CABG “Open Heart”
The term “open heart surgery” refers to any procedure where the chest is opened and surgeons operate directly on the heart or its blood vessels. Traditional CABG checks every box. A surgeon cuts through the breastbone (a median sternotomy), spreads the ribcage apart, stops the heart with a special solution, and connects the patient to a cardiopulmonary bypass machine that temporarily takes over pumping blood and delivering oxygen to the body.
While the heart is still, the surgeon takes a healthy blood vessel from another part of the body, often the chest wall or leg, and sews it onto the coronary artery above and below the blockage. This creates a detour for blood to reach the heart muscle, bypassing the narrowed section entirely. Depending on how many arteries are blocked, a patient might need one, two, three, or more grafts in a single operation.
Off-Pump and Minimally Invasive Variations
Not every CABG follows the traditional approach. Off-pump CABG (sometimes called “beating heart” surgery) still involves opening the chest through the breastbone, but the heart keeps beating throughout the procedure. The surgeon uses a small stabilizing device to hold the area of the heart being worked on steady. Because the chest is still fully opened, off-pump CABG is generally still classified as open heart surgery, even though the heart-lung machine isn’t used.
Minimally invasive approaches go a step further. In a procedure called MIDCAB (minimally invasive direct coronary artery bypass), the surgeon works through a small incision between the ribs rather than splitting the breastbone. The chest incision for robotic MIDCAB typically measures around 9 centimeters, compared to roughly 21 centimeters for a full sternotomy. Fully robotic CABG (called TECAB) uses even smaller port incisions, with a total chest incision length of about 7.5 centimeters. These techniques are performed on the beating heart and don’t require opening the chest in the traditional sense, so they fall outside the strict definition of open heart surgery.
Minimally invasive options aren’t available to everyone. They work best for patients who need one or two bypasses in locations the surgeon can reach through a small incision. Patients with more complex blockages typically need the full sternotomy.
Who Needs CABG Instead of a Stent
Many people with blocked coronary arteries can be treated with a stent, a tiny mesh tube threaded through a catheter and placed inside the artery to hold it open. This is a much less invasive procedure. So the decision to recommend CABG usually comes down to how many arteries are blocked and how complex the blockages are.
Patients with one or two blocked arteries are typically good candidates for stenting. CABG becomes the preferred option when three or more arteries are blocked, when the left main coronary artery (which supplies a large portion of the heart) has significant narrowing, or when the patient has diabetes along with multi-vessel disease. Doctors use a scoring system called the SYNTAX score to rate the complexity of the blockages. A high score, meaning more complex and widespread disease, points toward CABG because it offers more complete restoration of blood flow. A low score means either approach can work, and patients have more room to weigh their options.
The key advantage of CABG over stenting is that it bypasses the entire diseased segment of the artery rather than treating a single spot. This makes it more durable for patients with extensive coronary artery disease.
How Long Grafts Last
The type of blood vessel used as a graft matters enormously for long-term success. The internal mammary artery, which runs along the inside of the chest wall, is the gold standard. It stays open in 90 to 95 percent of patients 10 to 15 years after surgery. Vein grafts taken from the leg don’t hold up as well: roughly half fail within five to ten years, and most of the remaining ones develop significant buildup inside.
This is why surgeons use at least one internal mammary artery graft whenever possible, typically connecting it to the left anterior descending artery, the most important vessel on the front of the heart. Additional bypasses may use vein grafts or, increasingly, other arterial grafts to improve longevity.
What Surgery and Recovery Look Like
For traditional open heart CABG, the operation itself takes three to six hours. Afterward, you’ll spend a day or two in the intensive care unit. During that time, the medical team monitors your heart rhythm continuously, manages pain, and watches for complications. You’ll have drainage tubes in your chest, compression stockings on your legs to prevent blood clots, and possibly a temporary pacemaker to keep your heart rhythm steady.
Most patients spend about a week in the hospital total before going home. The breastbone takes approximately eight weeks to heal, and during that time you’ll need to avoid lifting anything heavy, driving, or pushing and pulling motions that stress the chest. Many people return to desk work in six to eight weeks, though physically demanding jobs may require three months or longer.
The in-hospital mortality rate for isolated CABG is about 1.6 percent, with 30-day mortality around 1.5 percent. Those numbers reflect averages across all patients, including older adults and those with other health conditions. For younger, otherwise healthy patients, the risk is lower. Five-year survival after CABG is approximately 90 percent, and at 10 years it’s around 77 percent, though these figures reflect the natural aging and health conditions of the patient population, not just the surgery itself.
On-Pump vs. Off-Pump Outcomes
Whether to use the heart-lung bypass machine remains a genuine debate in cardiac surgery. Early research suggested that off-pump CABG reduced certain complications like stroke, kidney injury, and the need for blood transfusions, likely because the bypass machine triggers an inflammatory response throughout the body. However, a large clinical trial called ROOBY found that off-pump patients had slightly higher rates of death, repeat procedures, or heart attacks at one year.
Current European guidelines recommend off-pump CABG mainly for high-risk patients, and only at surgical centers that perform it frequently. The technique is more demanding for the surgeon, and outcomes depend heavily on the team’s experience with it. For most patients, on-pump CABG remains the standard, and it is unambiguously open heart surgery.