Now in a “beating heart”!
Improving outcomes for coronary artery bypass surgery
If you have coronary artery disease, in which one or more of the main blood vessels is failing to feed your heart with blood and oxygen, you may be facing coronary artery bypass surgery, which nowadays, due to the desire to improve outcomes after surgery and advances in technology have led surgeons to perform coronary artery bypass surgery without cardiopulmonary bypass, called off-pump bypass (also called “beating heart”) surgery.
Traditionally, coronary artery bypass surgery is performed with the assistance of cardiopulmonary bypass. The heart-lung machine allows the heart’s beating to be stopped, so that the surgeon can operate on a surface which is blood-free and still. The heart-lung machine maintains life despite the lack of a heartbeat, removing carbon dioxide from the blood and replacing it with oxygen before pumping it around the body.
The heart-lung machine has saved countless lives. Off-pump coronary artery bypass surgery differs from traditional coronary artery bypass surgery, because the heart-lung machine is not used. Technological and medicine advances have been able to achieve a partial inhibition of the heart by maintaining its function of blood pumping into circulation. With a particular area of the heart stabilized, the surgeon can go ahead and bypass the blocked artery in a highly controlled operative environment. Meanwhile, the rest of the heart keeps pumping and circulating blood that is rich in oxygen to the body. Off-pump coronary artery bypass surgery may be performed in certain patients with coronary artery disease. With present technology, all arteries on the heart can be bypassed off-pump. This technique is ideal for certain patients who are at increased risk for complications from cardiopulmonary bypass, such as those who have heavy aortic calcification, carotid artery stenosis, or pulmonary or renal insufficiency, which means lowered kidney and lung function. The selection of patients who undergo off-pump surgery is made at the time of surgery when the patient’s heart and arteries are evaluated quickly more closely.
The heart beating coronary bypass is a possibility, but is it the best?!
The purpose of coronary bypass without the heart-lung machine is to reduce to the maximum possible complications of the traditional coronary bypass.
Who can benefit from the off-pump coronary bypass?
All those patients who have a high risk of developing complications from traditional bypass surgery, those who suffer from blood vessel disease, those who may have ischemic episodes, and patients of any age benefit more from the perfection of the bypass operator technique.
OPCAB (off-pump coronary artery bypass) can be performed in all patients, except those who come to the hospital in a cardiac shock condition. The purpose of this operation procedure is to minimize the risks and complications that occur to the patient from the use of the heart-lung machine. The International Association of Cardiac Surgery (IRM) based on several Meta-analyzes performed, has divided the OPCAB data in groups A and B compared to the classic bypass with the Heart-Lung Machine.
Cardio-thorax surgeons are increasingly trying to reduce to maximum the undesired potential side effects of both operating techniques, meaning that they are trying to find a way to catch embolism before it can damage different parts of the organisms and here we are talking of the traditional bypass that is most used by all cardiac surgeons. Meanwhile, in the coronary bypass without a car heart-lung surgery, cardiac surgeons are trying to accomplish the intervention by inhibiting smaller parts of the patient’s heart. The coronary bypass without the heart-lung machine is one of today’s major achievements in cardio-thorax surgery and medicine, thanks to which many patients suffering from coronary artery disease will be completely cured, without any unwanted post-operative consequences! In our hospital, now and onwards, all patients who need isolated bypass surgical intervention (with no need of intervention in the valve system) will be operated only by this method.
Benefits of Off-Pump Coronary Bypass (OPCAB)
- OPCAB (the Heart Beating Bypass) – is preferred and useful in patients who have a pronounced atherosclerosis throughout the arterial system and especially in those patients whose aortic is affected by this arteriosclerosis (calcification).
- By not touching the aorta, as done with the traditional method, the risk that the patient in the postoperative phase suffers from a cerebral ischemia is reduced to almost zero – this is also confirmed by a group of American Heart Association (AHA) researchers.
- It is preferred in patients with lung problems, especially in patients suffering from chronic respiratory tract obstruction (COPD), and in patients with kidney problems (renal insufficiency).
- Embolism risk is diminished.
- Usually, the patients do not need blood transfusion.
- Blood cells are not damaged at all, unlike the Heart-Lung Machine surgery, because they have no contact with the mechanical forces of the heart-lung machine.
- Patients have no immunosuppressive reaction as a result of blood contact with foreign objects, such as the operation of the heart – lung machine.
- Patient’s stay in the intensive care ward is shorter.