Beating heart bypass or Off pump coronary artery bypass known as OPCAB is a type of open heart surgery that is performed without the use of cardiopulmonary bypass equipment or heart lung machine. While it still employs the sternal or breastbone incision known as a medial sternotomy, being able to avoid cardiopulmonary bypass is by itself a significant advantage.
Coronary artery bypass operations are commonly employed as a treatment option for advanced symptomatic coronary artery disease. Several hundred thousand heart bypass operations are performed annually in the United States alone.
Traditionally, bypass operations have required the heart to be stopped to eliminate movement and ensure a blood-less environment while the cardiothoracic surgeon works on the surface of the heart attaching grafts.
Coronary bypass grafts, which are portions of the patients own veins and arteries are attached to healthier portions of the coronary arteries 'downstream' from the partially or completely blocked segment and upstream into the ascending Aorta...thus bypassing or detouring a portion of coronary artery that is significantly diseased and causing obstruction to blood flow
This process allows freshly oxygenated, nutrient rich blood to reach
the heart muscle without difficulty and usually eliminates...at least
for a period of several years...the typical symptoms associated with
blood flow limiting heart disease...namely chest pain and shortness of
breath. It does not treat the cause of coronary heart disease however.
bypass operations are of course not without risk and the introduction
of beating heart bypass surgery was introduced as a way of reducing the
inherent risks of the procedure while improving cost efficiency by
reducing post operative high dependency unit and total hospital stay
times for patients.
When a heart surgeon uses an off pump heart surgery approach to attach bypass grafts to the patients heart, the heart remains beating. This of course presents certain challenges to the surgeon. For example, graftable coronary arteries are typically about 3.5mm down to 1.5mm in diameter. A small incision has to be made in the side of the 'target vessel' where the graft has been chosen to be attached. The graft attachment area is called the 'site of anastamosis'. Then the end or sometimes the side of the graft has to be carefully sewn into the target vessel so that the join is complete and will not interfere with normal blood flow.
Performing this type of procedure accurately on a stopped heart is difficult enough...so how are coronary artery grafts successfully attached to a moving target such as a beating heart?
Clearly, the target area still needs to be kept as close to stationary
as possible. Fortunately, certain technological advances have enabled
bypass on a moving heart to be carried out with a great deal of success.
The OPCAB technique has been shown statistically to be a real
contender with traditional on-pump bypass in
certain patient groups...at least in the short term as it is a much more recent
procedure than traditional CABG and as such long term data is not available.
Advanced Medical equipment and technology companies market devices that are designed to stabilize the surface of the heart while a graft is attached. One such device from the Medtronic cardiac surgery stable is the Octopus Tissue Stabilization System.
Multiple suction cups attached to the end of the flexible arm of the octopus heart device sit on the surface of the heart. When suction is applied to the area of the heart directly between the arrays of tiny suction cups, the surface is held steady...amazingly to within about 1mm of motion. This is still enough to allow the surgeon to perform coronary graft anastamosis while the heart is still beating normally.
Other techniques such as applying a loop-suture to isolate a section of coronary artery and reduce the blood flow within it, the placement of a shunt device into the artery to allow blood to flow through it while a graft incision is made in the wall of the coronary artery...followed by a graft attachment...and pharmaceutical drugs such as Adenosine and Esmolol to slow or even stop the heart for a few seconds are also utilized during the beating heart bypass procedure.
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This is VERY Good news!
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