What is coronary artery bypass graft (CABG) surgery and how is it different from stenting? 

When patients hear they have a blockage in their heart, they often assume a stent is the default cure. However, for complex or severe heart disease, stenting is sometimes just a temporary patch, whereas Coronary Artery Bypass Graft (CABG, pronounced ‘cabbage’) is a long-term renovation. While stenting opens the artery from the inside, CABG bypasses the problem entirely from the outside. 

What We’ll Discuss in This Article 

• The Analogy: Clearing the road (Stent) vs. Building a flyover (CABG). 

• The Procedure: What happens during ‘Open Heart Surgery.’ 

• The ‘Spare Parts’: Where do the new blood vessels come from? 

• The Heart-Lung Machine: Stopping the heart to sew. 

• Comparison Table: Invasiveness, Recovery, and Durability. 

• The Decision: Why diabetes or ‘triple vessel disease’ usually favors CABG. 

What is CABG? (The ‘Flyover’ Analogy) 

Think of your blocked artery as a highway blocked by a landslide. 

• Stenting (Angioplasty): This is like sending a bulldozer in to push the rocks aside and shore up the walls with a metal tunnel. You are still using the old road. 

• CABG (Bypass): This is like building a completely new ‘flyover’ or detour road around the landslide. Traffic (blood) flows through the new road, completely ignoring the blockage. 

The Procedure

CABG is major surgery. It requires a general anaesthetic and usually involves a ‘sternotomy, cutting through the breastbone to access the heart.  

1. Harvesting: The surgeon takes a healthy blood vessel from another part of your body (leg, arm, or chest wall).  

2. The Bypass: One end of this healthy vessel is sewn onto the aorta (the main pipe leaving the heart), and the other end is sewn onto the coronary artery past the blockage. 

3. The Result: Blood flows freely through the new graft, restoring oxygen to the starving heart muscle.  

Where do the ‘Spare Parts’ come from? 

Surgeons use your own blood vessels as grafts. 

• The Gold Standard (LIMA): The Left Internal Mammary Artery runs inside your chest wall. It is the best graft because it rarely blocks up again. It is almost always used to bypass the most important heart artery (the LAD). 

• The Leg (Saphenous Vein): A long vein from your leg. It is easy to access but slightly more prone to blocking over 10–15 years. 

• The Arm (Radial Artery): Sometimes an artery from the wrist is used.  

CABG vs. Stenting: The Major Differences 

The choice between the two is not just about preference; it is about the ‘complexity’ of your disease. 

Feature	Stenting (PCI)	Bypass Surgery (CABG)
Invasiveness	Minimally Invasive (Pinhole in wrist)	Major Surgery (Open chest)
Anaesthetic	Local (You are awake)	General (You are asleep)
Hospital Stay	1 day	5–7 days
Recovery	1 week	6–12 weeks (Bone healing)
Durability	Higher risk of repeat narrowing	Excellent (Lasts 10–20+ years)
Best For	1 or 2 narrowings	3+ narrowings or Diabetes

Why would anyone choose the big surgery? 

It seems frightening to choose open-heart surgery over a simple wrist procedure. However, for certain patients, CABG saves lives better than stents. 

• Diabetes: Diabetic patients have ‘diffuse’ disease (long, crumbling plaques). Stents often fail in these arteries, whereas bypasses jump over the whole diseased section. 

• Triple Vessel Disease: If all three main arteries are blocked, fixing them with stents would require 5 or 6 metal tubes, which is risky. A triple bypass is a cleaner, more durable solution. 

• Longevity: A successful bypass often means you won’t need another procedure for decades. Stents may require repeat visits. 

The ‘Pump’ (Heart-Lung Machine) 

In traditional CABG, the surgeon stops your heart to sew the tiny vessels precisely. While the heart is stopped, a Cardiopulmonary Bypass Machine takes over the job of pumping blood and oxygenating it for your body.  

• Off-Pump (Beating Heart) Surgery: Some skilled surgeons now perform the operation while the heart is still beating, using a stabiliser to hold just a small section still.⁹ This reduces the risk of stroke but is technically harder. 

Conclusion 

Stenting is a plumbing fix; CABG is a construction project. While the recovery from CABG is undoubtedly tougher, involving a healing breastbone and a scar on your leg, it remains the gold standard for complex heart disease. It offers the best chance of a long, symptom-free life for patients with diabetes or extensive blockages. 

If your ‘Heart Team’ (surgeon and cardiologist) recommends CABG over stenting, it is because they believe the short-term pain of surgery is worth the long-term gain in survival. 

Authority Snapshot 

This article was written by Dr. Stefan Petrov, a UK-trained physician (MBBS) with extensive experience in surgical and cardiac care. Having managed the post-operative recovery of CABG patients in intensive care units, Dr. Petrov explains the critical differences between ‘open heart surgery’ and the less invasive ‘stenting’ option. This content has been reviewed to ensure strict alignment with NHS and NICE guidelines, helping you understand why your surgeon might recommend the bigger operation over the smaller one.