Overview

Off Pump - Beating Heart

"Off-pump" bypass surgery is a relatively new procedure using recently available technology to allow surgeons to bypass coronary arteries without stopping the beating heart and using a relatively small incision(indeed, off-pump surgery is sometimes referred to as "beating-heart" surgery). In contrast, in conventional on-pump surgery the heart is stopped for a period of time so the doctor can do the grafting, and during this time the patient's blood is artificially circulated to the rest of the body via a specialized pump (called the heart-lung bypass machine). This bypass pump is thought to be at least partially responsible for some of the complications seen after bypass surgery.

Indications for Beating Heart Bypass Surgery

All patients with coronary artery disease are possibly candidates for off-pump coronary artery bypass.

Some surgeons in certain settings prefer the more traditional CABG technique : -

younger patients
where the coronary arteries are small and several bypasses are indicated
patients whose hearts may not tolerate the various manipulations required during beating heart surgery

Off-pump CABG Surgery Is Performed :

Beating heart CABG (BHCABG) surgery, also called off-pump coronary artery bypass surgery (OPCAB), reduces the risks associated with the use of the heart-lung machine. During a beating heart CABG surgery, the heart continues to beat while the surgeon delicately grafts the bypass. The surgeon uses a stabilization device to still the small area of the beating heart where the bypass is being grafted.


Currently, the categories of patients with coronary artery disease who are potential candidates for this type of surgery include : -

Those with poor heart function (very low ejection fraction)
Individuals with severe lung disease (chronic obstructive pulmonary disease, and emphysema)
Those suffering from acute or chronic kidney disease
Those at a high risk for stroke
patients with a calcified aorta

The stabilization device utilizes small suction pods that gently attach to the surface of the heart. The pods work by lifting, not pushing down on the tissue, to stabilize the area where the surgeon will graft the bypass. The device is flexible so that it can be positioned on the heart vessels, yet sturdy so it can steady a portion of the beating heart while minimally affecting heart function.

Benefits of beating-heart surgery

Complete recovery from a traditional CABG surgery ranges from four to six weeks. In contrast, recovery time for patients with beating heart CABG surgery has been reported to be as short as three to four weeks. Patients are often awake much earlier after surgery and experience quicker recoveries than patients who have been placed on a heart-lung machine. Hospitalization is generally shorter when compared to traditional operations using cardiopulmonary bypass. Best of all, the risk of stroke and the need for blood transfusions is substantially reduced with beating heart CABG surgery.

Some More Benefits :

Better preservation of heart function
Better survival rate, especially among high-risk patients
Reduced hospital stay
Quicker recovery
Less chance for heart rhythm, kidney, or liver complications
Reduced risk for neurological injury, including stroke and memory complications


You may be a candidate for Off-pump - beating heart surgery if you :

Have single or multiple coronary arterial blockages.
Are a new candidate for angioplasty or if you have recurrent problems after a previously successful angioplasty.
Have undergone a conventional bypass surgery and now have recurring or new blockages in the grafts.
Have medical problems such as decreased heart function or a history of stroke or pulmonary disease.
Require a less-invasive form of surgery.
Refuse blood products.

Each patient's diagnosis is unique and your physician will recommend the best approach for you.

Beating Heart Bypass Surgery Procedure

First, your surgeon removes a section of a healthy vein or artery from an area of your body. This is called a graft. The surgeon attaches one end of the graft to an area of the heart above the blockage in your artery. The other end is attached to an area of your coronary artery below the blockage. Once the graft is attached, blood flow to your heart is restored.

Two types of graft bypasses : -

The challenge in beating heart CABG surgery is that it can be difficult to suture or "sew" on a beating heart. The surgeon must use a "stabilization" system to keep the heart steady.

The stabilization system consists of a heart positioner and a tissue stabilizer. The heart positioner guides and holds the heart in a position that provides the best access to the blocked arteries. The tissue stabilizer holds a small area of the heart still while a surgeon works on it.

The stabilizers are designed to position and to hold the heart to give the surgeon easy access to the blocked vessel requiring the bypass graft. The Stabilizer minimizes limits the motion of a small area of the heart while the rest of the heart continues to beat normally. This allows the surgeon to perform CABG surgery without stopping your heart and without using the heart-lung machine.

Conventional On Pump Coronary Artery Bypass Surgery

More than 70%2 of all bypass surgeries are performed on a stopped heart. Unlike beating heart surgery, during conventional on pump heart bypass, medication is used to stop your heart.

A heart-lung machine takes over the function of your heart and lungs during the surgery. The heart-lung machine is also called a cardiopulmonary bypass machine. It has a pump to function as the heart and a membrane oxygenator to function as the lungs


A patient is placed on cardiopulmonary bypass (the heart lung machine) during conventional open heart surgery. The Performer CPB System, an advanced heart-lung machine, takes over the job of keeping oxygen-rich blood circulating throughout the body during conventional CABG surgery. This allows the surgeon to perform the surgery on a still heart




After Surgery :

After surgery, the patients are shifted to the intensive care unit. The ICU stay is generally two to three days. While in the intensive care unit, a ventilator is used to assist the breathing process. Once the patient stabilizes and is able to breathe adequately unassisted the breathing tube is removed.

While recovering from the general anesthesia, grogginess and some disorientation maybe experienced. Pain medication is used to help reduce the pain from the incision.

Intravenous fluids maintain hydration. The one or more temporary drainage tubes are placed in the chest cavity drain any excess blood or fluid that may build up after surgery. Blood transfusions maybe required during or even after the operation. There may be a need to use some medication to support the heart function during and after the operation.

Off-pump beating heart surgery patients typically spend one day in the surgical intensive care unit before being moved to a regular surgery unit, where they receive cardiac rehabilitation. The average hospital stay is 5 to 7 days.

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