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Heart & Vascular Health
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Beating-Heart Surgery Makes Sense – For Some

Surgeons must decide whether to use heart-lung machine

Coronary artery bypass graft surgery has been successfully performed for more than 55 years and on thousands of patients. As a standard part of the procedure, a heart and lung bypass machine re-oxygenates your blood and keeps your circulation going while surgeons work on your silent, still heart. 

An alternative to this surgery is so-called off-pump surgery. In this type of surgery, your heart continues to beat throughout the grafting procedure. In this way, the use of the heart-lung machine is avoided, and this can be important for patients with certain conditions.

Each heart patient is different, and careful consideration must be given to current and past history. Then, we can determine the best possible surgical treatment so that we can achieve the best possible outcome following surgery.

Study findings vary

There are many findings that question the wisdom of the routine use of off-pump bypass during coronary artery bypass graft surgery. 

Many of those studies have found that though off-pump surgery may have better short-term, in-hospital survival, long-term outcomes do not seem to be as good as outcomes after traditional, on-pump surgery.

Off-pump bypass has been suggested to lessen confusion and “mental fog” shortly after heart surgery. About two months after surgery, though, just about everyone is back to normal, and we now know that neither type of surgery has a meaningful advantage.

More observations

One issue that arises with off-pump bypass is that the grafts (new pathways that bypass the blocked arteries) do not appear to last as long following off-pump surgery as those grafts made during on-pump surgery.

Another issue is that following off-pump bypass surgery, vascularization seems to be less complete, and we take this to mean that it’s less likely that all the blocked arteries were treated or bypassed.

Technique still valid

Even though off-pump bypass seems to have some drawbacks when compared with on-pump bypass, this does not mean that off-pump bypass should be abandoned entirely.

When analyzing the benefit versus deficits of off-pump surgery we must look at the entire picture. Off-pump surgery was developed in the hope of finding a better, safer option for those patients who have high risk for complications during traditional on-pump surgery.

In determining whether a patient should have on-pump or off-pump surgery, we need to take into account the risk of the patient due to the heart-lung bypass machine and the ability for revascularization; or to effectively treat the occluded blood vessels that feed the heart.

Common sense and experience

We usually determine if a patient should have an off-pump procedure at the start of surgery. Of course, this means that the surgeon must be capable of performing either procedure skillfully and that the surgical team be equally prepared to successfully transition from one type of procedure to the other.

The key in any kind of heart coronary artery bypass procedure is having a surgeon who is highly experienced and is an expert in both techniques – and one who will perform the surgery that is best for you.

Tags: cardiology, coronary artery bypass grafting, heart surgery
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Joseph F. Sabik III, MD, is Chairman of the Department of Thoracic and Cardiovascular Surgery at Cleveland Clinic and directs the Clinic’s Cardiothoracic Training Program.

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