Surgery on the beating heart is technically more difficult for the surgeon. Depending on the location of your blockage, it may not be able to be reached and repaired without rotating the heart. This movement can cause changes in your heart rhythm. The pros and cons for your individual case need to be evaluated and a decision made based on what's best for you.

Regardless of the use of on-pump or off-pump techniques, bypass grafts in a Coronary Artery Bypass are generally placed in the same fashion: first, the surgeon opens the coronary artery a short distance from the blockage. The surgeon then connects the healthy artery or vein to the side of the coronary artery. Next, a tiny hole is made in the aorta, and then the healthy vein or artery is connected to the aorta at that point. The surgeon repeats the process for any remaining grafts. (A double bypass does this twice. A triple bypass involves three grafts, and so on.) The last step is checking to make sure that the grafts supply adequate blood to the heart, and then closing up the chest.