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.

How Beating Heart CABG / Off-pump CABG Surgery Is Performed ?

Beating heart CABG (BHCABG) surgery, also called off-pump coronary artery bypass surgery (OPCAB), reduces the risks associated with the use of the heart-lung machine. During a beating heart CABG surgery, the heart continues to beat while the surgeon delicately grafts the bypass. The surgeon uses a stabilization device to still the small area of the beating heart where the bypass is being grafted.
The stabilization device utilizes small suction pods that gently attach to the surface of the heart. The pods work by lifting, not pushing down on the tissue, to stabilize the area where the surgeon will graft the bypass. The device is flexible so that it can be positioned on the heart vessels, yet sturdy so it can steady a portion of the beating heart while minimally affecting heart function.

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What are the Advantages of Off-Pump Coronary Bypass Surgery (OPCAB)?

An alternative to traditional CABG is off-pump or beating heart surgery, where surgeons don’t use the heart-lung machine. The procedure is also called OPCAB (Off-Pump Coronary Artery Bypass). The surgeons sew the bypasses onto the heart while it continues beating. Various types of heart stabilizers are used to restrain the heart one section at a time so the surgeon can operate on it. The chest is opened through a midline sternotomy incision. After the target coronary vessel is exposed and stabilized, it is occluded and opened. A bridging plastic tube — which allows blood flow during suturing — may be placed. The bypass graft is then sutured to the coronary artery.

The potential benefits/advantages of off-pump surgery may include the following : –

• Reduced need for blood transfusions
• Reduced risk of bleeding, stroke and kidney failure
• Potential for reduced psychomotor and cognitive problems

High-risk patients with additional diseases like lung disease, kidney failure and peripheral vascular disease may benefit from this kind of operation. The University of Maryland offers OPCAB primarily to these patients.

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