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Off-pump coronary artery bypass is a type of open-heart surgery that involves creating a new route for the blood to pass the artery blockage.

Coronary artery bypass surgery is a medical procedure that’s generally performed by forcing the heart to stop while the surgeon grafts another route for blood to flow past an artery blockage. This generally means that you will be connected to a heart-lung machine that takes over your breathing. There are situations where the surgeon chooses not to stop the heart, and this is known as off-pump coronary artery bypass surgery.

Off-pump coronary artery bypass surgery: Who needs this procedure?

If you have been diagnosed with coronary artery disease, you might get through it with dietary changes and a couple of prescribed meds. However, when one of the coronary arteries is already blocked by a blood clot, surgical intervention may be required.

People who have narrow arteries can get away with another procedure called an angioplasty. During this procedure, the doctor inserts a catheter with a balloon which is inflated to push the walls of the narrow artery further apart from one another. It’s also likely that the doctor will choose to insert a stent, a small mesh wire tube that will permanently stay in the artery, keeping it open.

However, when removing a blood clot from the coronary artery is not possible, the doctor has to use a healthy artery from your body to create a new path for the blood to follow, steering past the blockage. This is called a coronary artery bypass graft surgery.

What to expect before the procedure

When a surgeon chooses to perform an off-pump coronary artery bypass intervention, they will be transparent about it with the patient. They will also give out clear instructions on how to prepare for the intervention beforehand.

They will advise smokers to avoid cigarettes before the operation and might even ask them to avoid foods and drink the night before. You might also be required to stop taking drugs such as warfarin or aspirin before the surgery.

Doctors will also look to assess your health condition before performing open-heart surgery, to be fully aware of the potential risks. Blood tests are common, but so are EKGs and echocardiograms. In some cases, doctors also require that their patients do a cardiac stress test, as well as a chest X-ray.

What to expect during the procedure

An off-pump coronary artery bypass surgery requires general anesthesia, so you’ll not be conscious during the procedure. You can expect to spend several hours in operation, so tell your loved ones not to be alarmed. The surgeon will then proceed to make an incision and extract a healthy artery, typically from your leg or chest wall. This vessel will be used to create a new route for the blood to follow.

From this point on, the surgery can go one of two ways:

  • If your surgeon is performing a traditional off-pump coronary artery bypass surgery, they will make an incision in the middle of your chest to separate the breastbone.
  • If the surgeon opts for the minimally invasive approach to this procedure, the incision will be smaller. Then, they will use a camera and special instruments to perform the procedure. They could also make smaller holes in the chest instead of a large one, and some even use robotic arms to perform the intervention.

Unlike a standard coronary artery bypass surgery, during the off-pump version of the procedure, your heart will continue to beat at all times. The healthy vessel is used to bypass the blocked part of the coronary artery. When the procedure is complete, your breastbone will be wired back together, and the incision spot will be stapled or sewn.

Risks of having an off-pump coronary artery bypass surgery

Generally speaking, having the surgeon force your heart to stop involves more risks than allowing the heart to beat during this open-heart surgery. However, this doesn’t mean that off-pump coronary artery bypass surgery is risk-free. The risks vary depending on your current health condition, as well as your age.

Most of the time, this type of surgical intervention is successful, but some of the potential risks include infection at the incision site, bleeding during and after the procedure, blood clots that could cause a heart attack or a stroke, arrhythmia, or complications from anesthesia.

After the procedure

You will remain unconscious until the effects of the anesthetic wear off. While you are still in the hospital, your vital signs will be monitored at all times to make sure your heart is functioning normally. It’s also likely that you’ll have a tube inserted down your throat, to help you breathe. The tube usually stays there for about 24 hours after the procedure, during which you may feel uncomfortable and have trouble speaking.

Doctors will make sure that you are given pain medication if required, but you might feel discomfort nevertheless. You can resume drinking water a day after the procedure, but you might not be able to tolerate food right away. Depending on how fast you recover, you may be required to spend about five days in the hospital.

Once you leave the hospital, you will be instructed on how to go through the next few days. It normally takes about 10 days to have the staples or stitches removed, and the doctor will tell you all about the follow-up appointments (that you should never miss, even if you’re feeling better).

You will gradually recover from the procedure, so feeling exhausted in the first few days is perfectly normal. During your recovery period, you should avoid lifting weights, put too much stress on the body, and avoid driving until the doctor clears you for that.


Off-pump coronary artery bypass is a type of open-heart surgery that involves creating a new route for the blood to pass the artery blockage. Unlike a traditional coronary artery bypass, this procedure doesn’t require stopping the heart and using a heart-lung machine instead. The heart will continue to pump at all times. While there are a few risks revolving around this procedure, it’s typically not as risky as forcefully stopping the heart.