Advances in medicine include a way to make coronary artery bypass graft (CABG) surgery less invasive by avoiding the use of a cardiopulmonary bypass machine (heart-lung machine) during the operation.
The technique — called off-pump coronary artery bypass (OPCAB) surgery — is used in both women and men. However, OPCAB has been shown to reduce the higher mortality rates that accompany traditional coronary artery bypass surgery in women. When OPCAB was used in study groups of women, their mortality rates were equivalent to those of men, whereas mortality rates in women for CABG surgery using the heart-lung machine tend to be two to four times those of men.1,2
How OPCAB surgery is performed
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 may be stopped 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 immobilize 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 the bypasses are performed.
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 hospital discharge
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 may be candidates for off-pump surgery as long as the surgeon specializes in the procedure and has sufficient experience. The surgeon who specializes in this technique will evaluate each patient individually to determine candidacy. All arteries on the heart may 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 years of age, 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 (cardiac catheterization).
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, who routinely performs this procedure. 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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- Petro KR, Dullum MK, Garcia JM, Pfister AJ, Qazi AG, Boyce SW, Bafi AS, Stamou SC, Corso PJ. Minimally invasive coronary revascularization in women: A safe approach for a high-risk group. Heart Surg Forum. 2000;3(1):41-46.
- Brown PP, Mack MJ, Simon AW, Battaglia S, Tarkington L, Horner S, Culler SD, Becker ER. Outcomes experience with off-pump coronary artery bypass surgery in women. Annals of Thoracic Surgery. 2002;74(6):2113-2119; discussion 2120.