The Advantages of Beating-Heart (Off-Pump) Bypass Surgery
When bypass surgery is mentioned, what usually comes to mind is the classic method in which the heart is stopped and connected to the heart-lung machine (the pump). Yet in suitable patients we can also perform this operation while the heart keeps beating, without connecting it to the pump at all. In this article I will explain beating-heart (off-pump) bypass, in whom we prefer it and what the literature says about it.
What Is Off-Pump (Beating-Heart) Bypass?
In classic bypass the heart is stopped and the heart-lung machine temporarily takes over the task of pumping blood to the body; this allows us to work in a motionless field. In beating-heart bypass, on the other hand, we stabilise the part of the vessel to be sutured with special stabiliser instruments and complete the suture while the rest of the heart keeps beating.
The Benefits of Not Being Connected to the Heart-Lung Machine
Although the heart-lung machine is a life-saving technology, in some patients it can lead to a widespread inflammatory response in the body, temporary damage to blood cells and, rarely, fluctuations in kidney function. By not using the pump at all we aim to avoid these effects; large randomised trials show that beating-heart bypass reduces the rate of stroke in the short term.
Who Is Suitable for Beating-Heart Bypass?
In making this decision, the location of the vessels, the overall function of the heart and the urgency of the operation are decisive. Large randomised trials (CORONARY and ROOBY) have shown that the 30-day and 1-year results of beating-heart and on-pump bypass are broadly similar, but that experience and patient selection directly affect the outcome; for this reason we prefer this method not in every patient, but in cases where the anatomy is suitable and an experienced team is available.
Frequently Asked Questions
Is beating-heart bypass safer? It is generally considered to be of similar safety; while it may reduce the risk of stroke in the short term, long-term results can vary from patient to patient and according to the surgeon’s experience.
Can it be performed in every patient? No, the location of the vessels and the condition of the heart determine this decision; in some complex cases the on-pump method is a safer option.
Is graft quality lower in off-pump bypass? In experienced centres graft patency rates are close to those of the on-pump method; the decisive factor is the surgeon’s experience with this technique.
Conclusion
In the right patient, beating-heart bypass is a valuable technique that allows us to avoid the possible effects of the heart-lung machine. The decision is personalised according to the patient’s anatomy, general condition and the team’s experience with this method.
You can make an appointment for a detailed examination to assess which method of bypass surgery is suitable for you.
References
- Lamy A, Devereaux PJ, Prabhakaran D, et al. Off-Pump or On-Pump Coronary-Artery Bypass Grafting at 30 Days. N Engl J Med. 2012;366(16):1489-1497.
- Lamy A, Devereaux PJ, Prabhakaran D, et al. Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. N Engl J Med. 2016;375(24):2359-2368.
- Shroyer AL, Grover FL, Hattler B, et al. On-Pump versus Off-Pump Coronary-Artery Bypass Surgery. N Engl J Med. 2009;361(19):1827-1837.
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