To bypass the blockage, the surgeon makes a small opening just below the blockage in the diseased coronary artery. If a saphenous (leg) vein or radial (arm) artery is used, one end is connected to the coronary artery and the other to the aorta. If a mammary artery is used, one end is connected to the coronary artery while the other remains attached to its origin at left subclavian artery. The graft is sewn into the opening, redirecting the blood flow around this blockage. 
 
The procedure is repeated until all affected coronary arteries are treated. It is common for three or four coronary arteries to be bypassed during surgery. 
Before the patient leaves the hospital, the doctor or nurse will explain the specific bypass procedure that was performed.
 

• Heart-Lung Machine 

During surgery, the heart-lung bypass machine (called “on-pump” surgery) is used to take over for the heart and lungs, allowing the circulation of blood throughout the rest of the body. The heart’s beating is stopped so the surgeon can perform the bypass procedure on a “still” heart.

• Off-pump or beating heart bypass surgery

Off-pump or beating heart bypass surgery allows surgeons to perform surgery on the heart while it is still beating. The heart-lung machine is not used. The surgeon uses advanced operating equipment to stabilize (hold) portions of the heart and bypass the blocked artery in a highly controlled operative environment. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body

The goals of the procedure are to relieve symptoms of coronary artery disease (including angina), enable the patient to resume a normal lifestyle and to lower the risk of a heart attack or other heart problems.

As with any surgery, there are risks, including the possibility of:

• Complication associated with anesthesia, including respiratory or cardiac malfunction
• Infection
• Bleeding
• Stroke
• Arrhythmia
• Kidney failure
• Low cardiac output
• Perioperative myocardial infarction
• Death

Medical management, balloon angioplasty, or transmyocardial laser revascularization may be alternatives for some patients.

The decision to prescribe medical treatment, invasive procedures or cardiac bypass surgery depends on several factors including the extent of cardiovascular disease, the severity of symptoms, your age and other medical conditions. The cardiologist (heart specialist) and surgeon will determine the best method of therapy for each patient.