Off-pump coronary artery bypass

Off-pump coronary artery bypass
Intervention
MeSH	D047549

Off-pump coronary artery bypass or "beating heart" surgery is a form of coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass (heart-lung machine) as a treatment for coronary heart disease. During most bypass surgeries, the heart is stopped and a heart-lung machine takes over the work of the heart and lungs. When a cardiac surgeon chooses to perform the CABG procedure off-pump, also known as OPCAB (Off-pump Coronary Artery Bypass), the heart is still beating while the graft attachments are made to bypass a blockage.

Off-pump coronary artery bypass was developed partly to avoid the complications of cardiopulmonary bypass during cardiac surgery. The medical community believed cardiopulmonary bypass caused a post-operative cognitive decline known as postperfusion syndrome (informally called "pumphead"), but research has shown no long-term difference between on and off pump coronary artery bypass.^[1] in patients of lower risk.

However, sometimes the fatty type materials that collects to form a blockage or lining on the walls of the artery may break loose during CABG procedure manipulation. This debris can result in clots, or “emboli”, that may interrupt the flow of blood to the brain, causing neurological damage or even stroke. Data analysis from beating heart surgery patients shows a significant reduction in the release of this debris with correspondingly lower stroke rates. This may prove especially beneficial for more fragile patients with other risk factors or more than one medical condition.

In addition to off-pump surgery being associated with the clinical benefits of a reduced risk of stroke or memory problems, patients also typically have a faster recovery and shorter hospital stay, fewer blood transfusions, and fewer unwanted imflammatory/immune response issues.

Off-pump surgery can be more technically challenging. The technique has a steep learning curve, but with adequate training and experience, and the quality of the anastomoses has been shown to be similar to on-pump results in surgeons with comparable experience. Off-pump surgery remains a useful technique for some more complicated cases, such as people whose aorta is calcified.

See also

• Cardiac surgeon
• Coronary artery bypass surgery (CABG)
• Minimally invasive direct coronary artery bypass surgery (MIDCAB)
• Percutaneous coronary intervention (PCI), a.k.a. angioplasty

References

1. ^ Postperfusion syndrome

External links

• Myocardial Revascularization without Cardiopulmonary Bypass chapter by Todd M. Dewey and Michael J. Mack in Cardiac Surgey in the Adult
• Canadian study to test value of heart-lung machine during cardiac surgery