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Off Pump Coronary Artery Bypass Surgery

Recent advances in surgery and medical devices allow doctors to have less invasive options in the treatment of coronary artery disease (CAD), such as Beating Heart or “Off-Pump” Bypass Surgery.  Now individuals who have medical conditions such as diabetes, history of stroke, or poor physical health, can undergo cardiac surgery with lower risk for developing complications.  You will want to talk with your doctor to see if Off Pump Coronary Artery Bypass Surgery is an option for you.

Off Pump vs. Traditional Bypass Surgery

Off Pump Coronary Artery Bypass Surgery is different from traditional bypass surgery because it is performed while your heart is still beating.  Your surgeon does not use the heart-lung machine to stop your heart during the procedure.  In some cases, the surgeon may still need to use the heart-lung machine during the operation.  A perfusionist (a specialist trained to operate the heart-lung machine) may remain on standby during your operation.

With this approach, surgeons can perform multiple bypass grafts on all areas of the heart, including the backside (posterior), at the same time.  What this means is, the surgeon can perform a triple (three bypass grafts), quadruple (four bypass grafts) or more through a middle of the chest incision all off-pump.

Clinical Benefits of Off Pump Coronary Artery Bypass Surgery

Your physician may choose the beating heart bypass procedure for you because of benefits such as:

  • Decreased length of hospital stay 1, 2, 3
  • Less trauma due to the elimination of the heart-lung machine
  • Reduction in need for blood transfusions1, 2, 3
  • Fewer cognitive and neurological consequences4, 5 such as stroke6
  • In addition, a recent study presented in the New England Journal of Medicine showed that patients who are treated with traditional bypass surgery may suffer from lapses in mental acuity that result from brain damage caused by the stopped heart bypass surgery.

Out of 261 patients whose mental acuity diminished after bypass surgery:

  • 53% had diminished mental acuity at discharge
  • 36% had diminished mental acuity after 6 weeks
  • 24% had diminished mental acuity after 6 months
  • 42% had diminished mental acuity after 5 years7

Potential benefits of Beating Heart Bypass vs. Traditional Bypass surgery

When compared to traditional coronary artery bypass procedures that stop the patient’s heart and utilize a heart-lung machine, beating heart bypass procedures reduced:

  • Transfusion rates by 48%8
  • Length of post-operative hospital stay by 40%8
  • Hospital costs by 24%8
  • Post-operative cognitive dysfunction by 36% at 5 days and 90% at 3 months7

Clinical References

  1. van Dijk D et al. Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation, 2001 Oct 9;104(15):1761-6.
  2. Puskas JD et al. Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients. Annals of Thoracic Surgery, 2001 May, 71(5):1477-83.
  3. Puskas JD et al Off-Pump coronary artery bypass grafting provides complete revascularization while reducing myocardial injury, transfusion requirements and length of stay: Prospective randomized comparison of 200 unselected patients having OPCAB Verses conventional CABG. Journal of Thoracic and Cardiovascular Surgery. (in press). Newman, MF et al.; Longitudinal Assessment of Neurocognitive Function After Coronary Artery Bypass Surgery. New England Journal of Medicine, February 8, 2001, 344 (6): 395-402
  4. Lee JD et al. Off pump coronary artery bypass reduces neurological and clinical morbidity: A prospective randomized trial. Paper presented the Asia Pacific Scientific Forum, April 23-26, 2002, Honolulu, HI.
  5. Stamou SC et al. Stroke after conventional versus minimally invasive coronary artery bypass. Annals of Thoracic Surgery 2002 Aug;74(2):394-9.
  6. Puskas JD; Wright CE, Ronson RS; Brown WM; Gott JP; Guyton RA. Clinical Outcomes and Angiographic Patency in 125 Consecutive Off-Pump Coronary Bypass Patients. Heart Surgery Forum 1999; 2(3): 216-221
  7. Murkin JM; Boyd WD; Ganapathy S; Adams SJ; Peterson RC; Beating heart surgery: why expect less central nervous system morbidity? Annals of Thoracic Surgery, 1999 Oct, 68(4): 1498-501
  8. Puskas JD et al. Comparison of hospital cost for on versus off pump coronary surgery: Results from a randomized trial. Paper presented at the annual meeting of the American Heart Association, November 18, 2002, Chicago, IL.
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