New advances in medicine include a way to make heart surgery less invasive—by avoiding placing a patient on a cardiopulmonary bypass (heart-lung) machine—while the coronary artery is bypassed. Dr. Damiano, a Barnes-Jewish & Washington University Heart & Vascular Center surgeon, performs nearly 90 percent of bypass surgeries using the off-pump method. It is predicted that the majority of bypass surgeries will be done off-pump in the future.
Advantages of Off-Pump Bypass
In the off-pump or beating heart technique, the coronary artery bypass is carried out while the heart continues to beat. The same type of sternum incision used in a traditional coronary artery bypass is used, but once the heart is exposed, a stabilizer is used instead of a heart-lung machine. The stabilizing device is made of stainless steel and plastic and uses suction pods to grasp the epicardium (outer layer of heart tissue) while the heart is repositioned and vascular repairs are made.
Known in the medical world as OPCAB (off-pump coronary artery bypass), this technique may help patients avoid the inflammation and neurological deficits associated with the heart-lung machine. The procedure also may offer patients other important advantages:
reduced risk of stroke
fewer complications associated with the lungs
less need for blood transfusions
less injury to the heart muscle
faster discharge from the hospital
Although patients are discharged sooner with off-pump surgery, the four-to-six-week healing time from the incision (sternotomy) is similar to that of conventional bypass surgery.
Who is a Candidate for Off-Pump Bypass?
Nearly all patients are candidates for off-pump as long as the surgeon specializes in the procedure and has sufficient experience. All arteries on the heart can be reached with modern exposure techniques. A surgeon can bypass up to six vessels without relying on a heart-lung machine. For high-risk patients with cerebral vascular problems, pulmonary or kidney disease, bleeding disorders, as well as patients older than 70, off-pump surgery is an excellent option and offers significant advantages.
However, patients who are not good candidates for off-pump surgery include those who require an associated valve operation or surgery on the aorta, or who have poorly visualized target vessels on angiography.
Patients with single vessel disease may be candidates for even less invasive approaches. Instead of the 12- to 18-inch incision required to divide the sternum, patients with limited disease can undergo either a small, left anterior thoracotomy (4-5 cm incision), or an endoscopic approach.
To make an appointment with a Washington University heart or vascular specialist at Barnes-Jewish Hospital, call 855.925.0631.