Off-pump coronary artery bypass
Encyclopedia
Off-pump coronary artery bypass or "beating heart" surgery is a form of coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass (heart-lung machine) as a treatment for coronary heart disease
. During most bypass surgeries, the heart is stopped and a heart-lung machine takes over the work of the heart and lungs. When a cardiac surgeon chooses to perform the CABG procedure off-pump, also known as OPCAB (Off-pump Coronary Artery Bypass), the heart is still beating while the graft attachments are made to bypass a blockage.
Off-pump coronary artery bypass was developed partly to avoid the complications of cardiopulmonary bypass during cardiac surgery. The medical community believed cardiopulmonary bypass caused a post-operative cognitive decline known as postperfusion syndrome
(informally called "pumphead"), but research has shown no long-term difference between on and off pump coronary artery bypass. in patients of lower risk.
However, sometimes the fatty type materials that collects to form a blockage or lining on the walls of the artery may break loose during CABG procedure manipulation. This debris can result in clots, or “emboli”, that may interrupt the flow of blood to the brain, causing neurological damage or even stroke. Data analysis from beating heart surgery patients shows a significant reduction in the release of this debris with correspondingly lower stroke rates. This may prove especially beneficial for more fragile patients with other risk factors or more than one medical condition.
In addition to off-pump surgery being associated with the clinical benefits of a reduced risk of stroke or memory problems, patients also typically have a faster recovery and shorter hospital stay, fewer blood transfusion
s, and fewer unwanted imflammatory/immune response issues.
Off-pump surgery can be more technically challenging. The technique has a steep learning curve
, but with adequate training and experience, and the quality of the anastomoses
has been shown to be similar to on-pump results in surgeons with comparable experience. Off-pump surgery remains a useful technique for some more complicated cases, such as people whose aorta is calcified.
Coronary heart disease
Coronary artery disease is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium with oxygen and nutrients. It is sometimes also called coronary heart disease...
. During most bypass surgeries, the heart is stopped and a heart-lung machine takes over the work of the heart and lungs. When a cardiac surgeon chooses to perform the CABG procedure off-pump, also known as OPCAB (Off-pump Coronary Artery Bypass), the heart is still beating while the graft attachments are made to bypass a blockage.
Off-pump coronary artery bypass was developed partly to avoid the complications of cardiopulmonary bypass during cardiac surgery. The medical community believed cardiopulmonary bypass caused a post-operative cognitive decline known as postperfusion syndrome
Postperfusion syndrome
Postperfusion syndrome, also known as "pumphead" is a constellation of neurocognitive impairments attributed to cardiopulmonary bypass during cardiac surgery. Symptoms of postperfusion syndrome are subtle and include defects associated with attention, concentration, short term memory, fine motor...
(informally called "pumphead"), but research has shown no long-term difference between on and off pump coronary artery bypass. in patients of lower risk.
However, sometimes the fatty type materials that collects to form a blockage or lining on the walls of the artery may break loose during CABG procedure manipulation. This debris can result in clots, or “emboli”, that may interrupt the flow of blood to the brain, causing neurological damage or even stroke. Data analysis from beating heart surgery patients shows a significant reduction in the release of this debris with correspondingly lower stroke rates. This may prove especially beneficial for more fragile patients with other risk factors or more than one medical condition.
In addition to off-pump surgery being associated with the clinical benefits of a reduced risk of stroke or memory problems, patients also typically have a faster recovery and shorter hospital stay, fewer blood transfusion
Blood transfusion
Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...
s, and fewer unwanted imflammatory/immune response issues.
Off-pump surgery can be more technically challenging. The technique has a steep learning curve
Learning curve
A learning curve is a graphical representation of the changing rate of learning for a given activity or tool. Typically, the increase in retention of information is sharpest after the initial attempts, and then gradually evens out, meaning that less and less new information is retained after each...
, but with adequate training and experience, and the quality of the anastomoses
Anastomosis
An anastomosis is the reconnection of two streams that previously branched out, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....
has been shown to be similar to on-pump results in surgeons with comparable experience. Off-pump surgery remains a useful technique for some more complicated cases, such as people whose aorta is calcified.
See also
- Cardiac surgeonCardiac surgeonA cardiac surgeon is a surgeon who performs cardiac surgery—operative procedures on the heart and great vessels.-Training:A cardiac surgery residency typically comprises anywhere from six to nine years of training to become a fully qualified surgeon...
- Coronary artery bypass surgeryCoronary artery bypass surgeryCoronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease...
(CABG) - Minimally invasive direct coronary artery bypass surgeryMinimally invasive direct coronary artery bypass surgeryMinimally Invasive Direct Coronary Artery Bypass is a surgical treatment for coronary heart disease that is a less invasive method of coronary artery bypass surgery . MIDCAB gains surgical access to the heart with a smaller incision than other types of CABG...
(MIDCAB) - Percutaneous coronary interventionPercutaneous coronary interventionPercutaneous coronary intervention , commonly known as coronary angioplasty or simply angioplasty, is one therapeutic procedure used to treat the stenotic coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the build up of cholesterol-laden plaques...
(PCI), a.k.a. angioplasty
External links
- Myocardial Revascularization without Cardiopulmonary Bypass chapter by Todd M. Dewey and Michael J. Mack in Cardiac Surgey in the Adult
- Canadian study to test value of heart-lung machine during cardiac surgery