When your arteries cannot supply enough blood to your heart, your doctor may recommend coronary artery bypass graft (CABG) surgery. One of the most common heart surgeries in the United States, CABG surgery restores blood flow to your heart.
Approximately every 10 minutes, someone has beating heart or "off-pump" bypass surgery. Beating heart bypass surgery is - in simple terms - bypass surgery that is performed on your heart while it is beating. Your heart will not be stopped during surgery. You will not need a heart-lung machine. Your heart and lungs will continue to perform during your surgery.
Surgeons use a tissue stabilization system to immobilize the area of the heart where they need to work.
Beating heart bypass surgery is also called Off Pump Coronary Artery Bypass Surgery (OPCAB). Both OPCAB and conventional on-pump surgery restore blood flow to the heart. However, off-pump bypass surgery has proven to reduce side effects in certain types of patients.
Indications for Beating Heart Bypass Surgery
All patients with coronary artery disease are possibly candidates for off-pump coronary artery bypass.
Some surgeons in certain settings prefer the more traditional CABG technique : -
younger patients
where the coronary arteries are small and several bypasses are indicated
patients whose hearts may not tolerate the various manipulations required during beating heart surgery
Currently, the categories of patients with coronary artery disease who are potential candidates for this type of surgery include : -
Those with poor heart function (very low ejection fraction)
Individuals with severe lung disease (chronic obstructive pulmonary disease, and emphysema)
Those suffering from acute or chronic kidney disease
Those at a high risk for stroke
patients with a calcified aorta
Advantages of beating-heart surgery
Better preservation of heart function
Better survival rate, especially among high-risk patients
Reduced hospital stay
Quicker recovery
Less chance for heart rhythm, kidney, or liver complications
Reduced risk for neurological injury, including stroke and memory complications
What kind of surgeries are performed on a beating heart ?
At We Care partner hospitals, our cardiac surgeons opt to perform beating-heart surgery whenever possible. More than 90 percent of coronary artery bypass surgeries performed here are done on a beating heart.
While not all procedures can be performed on a beating heart, our surgeons have developed many techniques that make beating-heart surgery an option for even complex procedures on the inside of the heart--including valve repair. In fact, our surgeons were among the first in the world to perform beating-heart mitral valve surgery. The We Care partner hospital is one of the only hospitals in the nation where beating-heart surgery is being performed to treat valve disease.
Some of the procedures performed on a beating heart include : -
Coronary artery bypass graft surgery (including robotic and minimally invasive procedures such as TECAB and ThoraCAB, as well as open-chest, beating-heart bypass)
Surgery for atrial fibrillation
Treatment of some congenital heart defects, such as closure of atrial septal defect
Valve repair (mitral, pulmonary, or tricuspid)
Valve replacement (mitral or tricuspid)
Before Surgery
Members of the specialized surgical team counsel the patients who are to undergo the bypass surgery. They are given instructions to help prepare the patient for the surgery. These include advice on eating, drinking and taking medications.
The cardiologist, heart surgeon, anesthesiologist and nurse clinician meet with the patient. Questions are encouraged and attempts made to allay doubts. Admission is done at least a day prior to surgery.
Before surgery, certain tests are advised. : -
an echocardiogram (ultrasound of the heart) to evaluate the structure and function of the heart
cardiac catheterization (if not already done), to check for coronary artery disease or other cardiovascular disease
basic diagnostic tests, including blood tests, an electrocardiogram and a chest x-ray
customized more specialized tests such as an electrophysiology study (EP), maybe advised
Beating Heart Bypass Surgery Procedure
First, your surgeon removes a section of a healthy vein or artery from an area of your body. This is called a graft. The surgeon attaches one end of the graft to an area of the heart above the blockage in your artery. The other end is attached to an area of your coronary artery below the blockage. Once the graft is attached, blood flow to your heart is restored.
Two types of graft bypasses : -
The challenge in beating heart CABG surgery is that it can be difficult to suture or "sew" on a beating heart. The surgeon must use a "stabilization" system to keep the heart steady.
The stabilization system consists of a heart positioner and a tissue stabilizer. The heart positioner guides and holds the heart in a position that provides the best access to the blocked arteries. The tissue stabilizer holds a small area of the heart still while a surgeon works on it.
The stabilizers are designed to position and to hold the heart to give the surgeon easy access to the blocked vessel requiring the bypass graft. The Stabilizer minimizes limits the motion of a small area of the heart while the rest of the heart continues to beat normally. This allows the surgeon to perform CABG surgery without stopping your heart and without using the heart-lung machine.
Conventional On Pump Coronary Artery Bypass Surgery
More than 70%2 of all bypass surgeries are performed on a stopped heart. Unlike beating heart surgery, during conventional on pump heart bypass, medication is used to stop your heart.
A heart-lung machine takes over the function of your heart and lungs during the surgery. The heart-lung machine is also called a cardiopulmonary bypass machine. It has a pump to function as the heart and a membrane oxygenator to function as the lungs.
A patient is placed on cardiopulmonary bypass (the heart lung machine) during conventional open heart surgery. The Performer CPB System, an advanced heart-lung machine, takes over the job of keeping oxygen-rich blood circulating throughout the body during conventional CABG surgery. This allows the surgeon to perform the surgery on a still heart.
Heart-Lung Machine
This mechanical "heart and lungs" keeps oxygen rich blood circulating throughout your body. The heart-lung machine collects the blood. Carbon dioxide and other waste products are removed. The oxygenator adds oxygen, and the oxygenator's heat exchanger warms (or cools) the blood. The blood is gently circulated back through the body. This process is called perfusion. The person who operates the heart-lung machine is the perfusionist.
Stopping Your Heart
Your heart will usually be stopped for about 30-90 minutes of the 3-6 hour surgery. The heart-lung machine makes it possible for the surgeon to work on a still heart. This technique has been used for many years with excellent results. Once the surgery is over, the surgeon and perfusionist restart your heart.
After Surgery
After surgery, the patients are shifted to the intensive care unit. The ICU stay is generally two to three days.
While in the intensive care unit, a ventilator is used to assist the breathing process. Once the patient stabilizes and is able to breathe adequately unassisted the breathing tube is removed.
While recovering from the general anesthesia, grogginess and some disorientation maybe experienced. Pain medication is used to help reduce the pain from the incision.
Intravenous fluids maintain hydration. The one or more temporary drainage tubes are placed in the chest cavity drain any excess blood or fluid that may build up after surgery. Blood transfusions maybe required during or even after the operation. There may be a need to use some medication to support the heart function during and after the operation.
Off-pump beating heart surgery patients typically spend one day in the surgical intensive care unit before being moved to a regular surgery unit, where they receive cardiac rehabilitation.
The average hospital stay is 5 to 7 days.
After Leaving the Hospital
Recovery is usually rapid. Following bypass surgery, a recovery period of about 6 to 12 weeks can be expected. The main limitation to activity is healing of the sternum, which typically can take up to 12 weeks.
People in sedentary jobs frequently return to work after six weeks. It may take 12 weeks or more before returning to physically-demanding jobs.
Full energy levels usually start to return in about three months. The patients initially tire easily and their stamina may not be completely normal. Most return to normal activities after six months.
Most are able to drive in about three weeks. Sexual activity can be resumed in three to four weeks.
Most people resume normal activities while more than 90 percent have substantially less angina after a bypass surgery.
Coronary artery disease is a progressive disease. New blockages may occur while older blockages can progress. A second bypass, angioplasty or other procedure, or a change in medication maybe required.
The risk for this can be reduced by discontinuing smoking; eat healthy, taking prescribed medications and regular physical activity.
Cardiac rehabilitation after surgery helps. The focus is on customized lifestyle changes; diet, exercise as well as psychological issues.
The list of of world class heart hospitals in India is as follows : -
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Patient Storys
Successful heart surgery at We Care India partner hospital allows Robert Clarke to live a normal life despite a rare genetic disorder We Care india helped Robert find best super specialised surgeon for his rare conditions.
