Off-Pump Coronary Artery Bypass Surgery

Off-Pump Coronary Artery Bypass Surgery (OPCAB-Beating Heart Surgery)

What is it?

Arteries can become clogged over time by the buildup of fatty plaque, arteriosclerosis. Bypass surgery improves the blood flow and oxygen to the heart by rerouting, or "bypassing," blood around a section of clogged or diseased artery. Desires to improve outcomes after surgery and advances in technology have led surgeons to perform coronary artery bypass surgery without cardiopulmonary bypass. Off-pump coronary artery bypass (OPCAB) or beating heart surgery is done without stopping the heart.

How does it work?

During beating heart surgery, the heart-lung machine is not used. Instead, surgeons use special equipment to hold parts of the beating heart still while they are constructing the bypass grafts. Meanwhile, the rest of the heart keeps pumping blood to the body.

Reasons for Off-Pump Coronary Artery Bypass Surgery

Because medicines cannot clear blocked arteries, a severely narrowed coronary artery may need more treatment to relieve chest pain and reduce the risk of a heart attack. If percutaneous or transcatheter interventions (such as angioplasty and stenting) don’t clear the arteries, a patient may require coronary artery bypass surgery. Increasing blood flow to the heart muscle can relieve chest pain and reduces the risk of a heart attack.

Off-pump coronary artery bypass surgery may be performed in certain patients with coronary artery disease. With present technology, all arteries on the heart can be bypassed off-pump. It may be ideal for certain patients who are at increased risk for complications from cardiopulmonary bypass, such as those who have heavy aortic calcification, carotid artery stenosis, prior stroke, or compromised pulmonary or renal (kidney) function. Not all patients are candidates. Off-pump surgery is not suitable for patients who, in addition to the coronary bypass, require surgery to repair/replace their heart valves or to close a defect within the heart.

This is also a minimally invasive (limited access) heart surgery, which decreases trauma to the body and speeds up recovery, often by using smaller incisions during the surgery. Some of the benefits of limited-access surgery include:

  • A smaller incision
  • A smaller scar
  • Decreased chance of infection
  • Less bleeding during surgery
  • Less pain after surgery
  • A shorter hospital stay after surgery (usually 3 to 5 days after limited-access surgery, instead of 5 days or longer after traditional heart surgery)
  • A shorter recovery time (around 2 to 4 weeks, instead of the 6 to 8 weeks it takes to recover from traditional heart surgery)

What to expect

Surgeons perform limited-access operations through a small incision, often using special surgical instruments designed just for this kind of surgery. The incision is usually about 2 to 4 inches long and is made between the ribs, on the side of the chest. With traditional bypass surgery, the incision is usually 6 to 8 inches long and is made down the middle of the chest. Also, with limited-access operations, surgeons usually do not need to saw the breastbone open to gain access to the heart. Off-pump bypass surgery is performed this way about 75% of the time.

The procedure can take from two to six hours, depending on the number of bypasses needed. A three to five day hospital stay is required. Most patients are admitted to the hospital the day before surgery or, in some cases, on the morning of surgery. After being admitted to the hospital, the area to be operated on will be washed, scrubbed with antiseptic, and, if needed, shaved.

A mild tranquilizer, to relax the patient, will be given before entering the operating room. Small metal disks (electrodes) will be attached to the chest. These electrodes are connected to an electrocardiogram machine, which will monitor the heart's rhythm and electrical activity. The patient will then receive a local anesthetic to numb the area where a plastic tube (line) will be inserted in an artery in your wrist. An intravenous (IV) line will be inserted in the vein. The IV line will be used to give the anesthesia during the operation to make the patient sleep during the operation.

After the patient is completely asleep, a tube (ventilator) will be inserted down the windpipe and connected to a machine (respirator), which will take over breathing. Another tube will be inserted through the nose and down the throat, into the stomach. This tube will stop liquid and air from collecting in the stomach, so you the patient will not feel sick and bloated after surgery. A thin tube (catheter) will be inserted into the bladder to collect any urine produced during the operation.

The surgeon will then use certain heart stabilizers and positioners to keep the targeted region of the heart virtually motionless while working on a particular coronary artery. The heart maintains its own rhythm throughout the procedure.

A long piece of vein (graft) from the leg (the saphenous vein) may be removed. One end of the graft will be attached to the ascending aorta, the large artery that carries oxygen-rich blood out of the top of the heart to the body. The other end of the graft will be attached to a coronary artery below the blocked area. The surgeon may also choose to use an artery from the inside of the chest wall (the internal mammary artery). Or the surgeon may use both the vein and artery.

After surgery, the remaining hospital stay is for testing and monitoring the patient’s condition. Once discharged, a patient will be advised to enroll in a physician-supervised cardiac rehabilitation program. This program teaches lifestyle changes and helps rebuild strength and confidence.

St. Luke's Heart & Vascular