New advances in medicine include a way to make heart surgery less invasive – by avoiding placing a patient on a cardiopulmonary bypass machine (heart-lung machine) – while the coronary artery is bypassed.
During traditional bypass surgery, most patients are placed on a heart/lung machine, which reroutes the blood outside the body, oxygenates it and returns it to the body, so the heart is not moving during surgery.
In the off-pump or beating heart technique, the bypass of coronary arteries is carried out while the heart continues to beat. The surgeon gains access to the heart with a sternotomy (traditional mid-sternal incision) and uses stabilizers to hold steady the artery to be bypassed. The stabilizing device is made of stainless steel and plastic and uses suction pods to grasp the epicardium (outer layer of heart tissue) while the heart is repositioned and vascular repairs are made.
Known in the medical world as OPCAB (off-pump coronary artery bypass), this technique may help patients avoid the significant inflammatory response and some neurological deficits that have been associated with the heart-lung machine. The procedure also may offer patients other important advantages:
- Reduced risk of stroke
- Fewer complications associated with the lungs
- Less need for blood transfusions
- Less injury to the heart muscle
- Faster discharge from the hospital
Although patients are discharged sooner with off-pump surgery, the four-to-six-week healing time from the sternotomy is similar to that of conventional bypass surgery.
Who is a Candidate for Off-Pump?
Nearly all patients are candidates for off-pump surgery as long as the surgeon specializes in the procedure and has sufficient experience. All arteries on the heart can be reached with modern exposure techniques. A surgeon can bypass up to six vessels without relying on cardiopulmonary bypass. For high-risk patients with cerebral vascular problems, pulmonary or kidney disease, or bleeding disorders, as well as for patients older than 70, off-pump revascularization is an excellent option that offers significant advantages.
Patients who are not good candidates for off-pump surgery include those who require an associated valve operation or surgery on the aorta or who have poorly visualized target vessels on angiography.
Surgeons Who Perform Off-Pump
Washington University heart surgeons at Barnes-Jewish Hospital with extensive experience in off-pump surgery include Ralph Damiano Jr., MD, and Jennifer Lawton, MD. The Barnes-Jewish Hospital Heart Program is the only such program in Missouri and Illinois nationally ranked in the top 13 by U.S. News & World Report.
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