Off-pump coronary bypass surgery aims to minimize the incidence of complications resulting from off-pump coronary bypass surgery, such as stroke, kidney failure, and the need for blood transfusions.
Overview of Off-pump coronary bypass surgery
If you have coronary artery disease (CAD), in which one or more of the major blood vessels that feed your heart are blocked, you may have to undergo coronary bypass surgery.
The desire to improve outcomes after surgery and technological advances have led surgeons to perform coronary bypass surgery without cardiopulmonary bypass, called off-pump coronary bypass surgery (also called “beating heart” surgery).
Traditionally, coronary bypass surgery is performed with the help of a cardiopulmonary bypass pump.
The artificial heart-lung machine allows the heartbeat to stop, so the surgeon can work on a blood-free surface.
An artificial heart-lung machine sustains life despite the absence of a heartbeat, as it works to remove carbon dioxide from the blood and replace it with oxygen before pumping it throughout the body.
That is, it does the work of a human’s natural heart.
The artificial heart and lung machine has saved countless lives.
Off-pump coronary bypass surgery differs from traditional coronary bypass surgery because no artificial heart-lung machine is used.
Instead of stopping the heart, technological advances and new types of operating equipment allow the surgeon to stabilize parts of the heart during surgery.
With a certain area of the heart stabilized, the surgeon can go ahead and bypass the blocked artery in a highly controlled surgical environment.
Meanwhile, the rest of the heart continues to pump and circulate blood to the body.
Coronary bypass surgery can be performed without a pump in some patients with coronary artery disease.
With current technology, all arteries of the heart can be bypassed without a pump.
This solution may be ideal for some patients at increased risk of complications from cardiopulmonary bypass, such as those with heavy aortic calcification, cirrhosis of the liver, or poor lung or kidney function.
Of course, not all patients are suitable for off-pump coronary bypass surgery.
A patient who can undergo an off-pump procedure is selected after his or her heart and arteries are closely evaluated.
Off-pump coronary bypass surgery is now possible, but is it better?
Off-pump coronary bypass surgery aims to minimize the incidence of complications resulting from coronary artery bypass surgery, such as stroke, kidney failure, and the need for blood transfusions.
Going off-pump during off-pump coronary bypass surgery may also reduce the risk of so-called cognitive changes that have been observed in many patients undergoing coronary artery surgery with cardiopulmonary bypass.
Surgeons at the Cleveland Clinic completed a study to compare the outcomes of coronary artery bypass surgery with and without a pump.
Researchers compared 406 patients without a pump and 406 patients on a pump.
They found that the results of off-pump coronary bypass surgeries were excellent.
The risks of stroke, intraoperative heart attack, and death were similar and low in patients undergoing off-pump coronary bypass surgery.
One concern that has emerged in recent multicenter studies is that patients who did not use the pump had less complete vessel connections.
This means that fewer patients had their blood flow fully restored compared to patients who used the pump.
In fact, the American Heart Association’s findings in bypass surgery showed that fewer surgeons are now performing off-pump coronary bypass surgery.
However, note that the surgeons were able to regenerate blood vessels in almost all patients.
The results of off-pump coronary bypass surgery are excellent.
Both procedures have a very low risk of death, stroke, and myocardial infarction (heart attack).
The advantage of off-pump coronary bypass surgery is that coronary artery bypass graft morbidity can be significantly reduced in carefully selected patients.
We customize the off-pump coronary bypass surgery procedure according to the patient’s specific needs and circumstances. This helps deliver better results for patients.
Are there patients who may benefit from off-pump coronary bypass surgery?
Patients at high risk of cardiopulmonary bypass complications, such as people with vascular disease, previous strokes, or liver disease, may benefit from off-pump revascularization.
Surgeons are constantly looking for new ways to improve outcomes in both types of surgery.
For example, in on-pump surgery, improvements are being made to the heart-lung machine, and a filtering device that can catch small clots before any damage is done has been designed and is now being tested.
In off-pump coronary bypass surgery, different methods are being researched and developed to stabilize small parts of the heart during surgery so that the surgeon can work on them while the heart continues to pump blood.
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