Off-pump coronary artery bypass

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OPCAB
MeSH D047549

Off-pump coronary artery bypass (OPCAB), or beating-heart surgery, is a form of coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass (heart-lung machine) as a treatment for coronary heart disease. It was primarily developed in the early 1990s by Dr. Amano Atsushi. Historically, during bypass surgeries, the heart is stopped and a heart-lung machine takes over the work of the heart and lungs. When a cardiac surgeon chooses to perform the CABG procedure off-pump (OPCAB) the heart is still beating while the graft attachments are made to bypass a blockage.

Off-pump coronary artery bypass was developed partly to avoid the complications of cardiopulmonary bypass during cardiac surgery. It had been believed that cardiopulmonary bypass causes a post-operative cognitive decline known as a postperfusion syndrome (informally called "pumphead"), but research has shown no long-term difference between on and off pump coronary artery bypass [1] in patients of lower risk. This is probably because the pump is not the main cause of brain damage but is due to the formation of a clot or embolus.

Sometimes, the fatty type materials that collects to form a blockage or line on the walls of an artery may break loose during CABG procedure manipulation. This debris can result in clots, or emboli, that may interrupt the flow of blood to the brain, causing neurological damage or even stroke. Data analysis from beating-heart surgery patients shows a significant reduction in the release of this debris with correspondingly lower stroke rates.

The fatty emboli which cause brain damage are generated when the large artery from the heart (aorta) is manipulated and although these are reduced in most off-pump coronary bypass surgeries they are not eliminated because the aorta is still used as a site to attach some of the grafts. A growing number of OPCAB surgeons, however, are avoiding the aorta completely, known as "anaortic" or no-touch coronary bypass surgery, by taking all their grafts from sites other than the aorta (e.g. the internal mammary arteries.). [2] [3] This results in a very low risk of stroke, actually less than occurs during percutaneous coronary intervention. [4]

In addition to off-pump surgery being associated with the clinical benefits of a reduced risk of stroke or memory problems, patients also typically have a faster recovery and shorter hospital stay, fewer blood transfusions, and fewer unwanted inflammatory/immune response issues.

Minimally invasive direct coronary artery bypass surgery (MIDCAB) is a form of OPCAB that involves an incision rather than cutting into the sternum. [5] An advanced form of this is totally endoscopic coronary artery bypass surgery (TECAB) that uses robotic surgery. [6]

Off-pump surgery can be more technically challenging. The technique has a steep learning curve, but with adequate training and experience, the quality of the anastomoses has been shown to be similar to on-pump results in surgeons with comparable experience

On February 18, 2012, Amano Atsushi performed a successful off-pump coronary artery bypass operation on Emperor Akihito. [7]

Related Research Articles

<span class="mw-page-title-main">Cardiology</span> Branch of medicine dealing with the heart

Cardiology is the study of the heart. Cardiology is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease, and electrophysiology. Physicians who specialize in this field of medicine are called cardiologists, a sub-specialty of internal medicine. Pediatric cardiologists are pediatricians who specialize in cardiology. Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons, a specialty of general surgery.

<span class="mw-page-title-main">Coronary artery bypass surgery</span> Surgical procedure to restore normal blood flow to an obstructed coronary artery

Coronary artery bypass surgery, also known as coronary artery bypass graft, is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest pain caused by CAD, slow the progression of CAD, and increase life expectancy. It aims to bypass narrowings in heart arteries by using arteries or veins harvested from other parts of the body, thus restoring adequate blood supply to the previously ischemic heart.

<span class="mw-page-title-main">Cardiopulmonary bypass</span> Technique that temporarily takes over the function of the heart and lungs during surgery

Cardiopulmonary bypass (CPB) or heart-lung machine also called the pump or CPB pump is a machine that temporarily takes over the function of the heart and lungs during a cardiac surgery by maintaining the circulation of blood and oxygen throughout the body. As such it is an extracorporeal device.

<span class="mw-page-title-main">Cardiothoracic surgery</span> Medical specialty involved in surgical treatment of organs inside the thorax

Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart, lungs, and other pleural or mediastinal structures.

<span class="mw-page-title-main">Cardiac surgery</span> Type of surgery performed on the heart

Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease ; to correct congenital heart disease; or to treat valvular heart disease from various causes, including endocarditis, rheumatic heart disease, and atherosclerosis. It also includes heart transplantation.

<span class="mw-page-title-main">Internal thoracic artery</span> Artery of the thorax

In human anatomy, the internal thoracic artery (ITA), also known as the internal mammary artery, is an artery that supplies the anterior chest wall and the breasts. It is a paired artery, with one running along each side of the sternum, to continue after its bifurcation as the superior epigastric and musculophrenic arteries.

Hybrid coronary revascularization (HCR) or hybrid coronary bypass is a relatively new type of heart surgery that provides an alternative to traditional coronary artery bypass surgery (CABG) or percutaneous coronary intervention by combining the two into one operation. It is this combining aspect that "hybrid" refers to. HCR is one of several types of hybrid cardiac surgery; it is not to be confused with a MIDCAB procedure, which uses the smaller thoracotomy incision but does not involve coronary stenting.

A vascular bypass is a surgical procedure performed to redirect blood flow from one area to another by reconnecting blood vessels. Often, this is done to bypass around a diseased artery, from an area of normal blood flow to another relatively normal area. It is commonly performed due to inadequate blood flow (ischemia) caused by atherosclerosis, as a part of organ transplantation, or for vascular access in hemodialysis. In general, someone's own vein (autograft) is the preferred graft material for a vascular bypass, but other types of grafts such as polytetrafluoroethylene (Teflon), polyethylene terephthalate (Dacron), or a different person's vein (allograft) are also commonly used. Arteries can also serve as vascular grafts. A surgeon sews the graft to the source and target vessels by hand using surgical suture, creating a surgical anastomosis.

Minimally invasive direct coronary artery bypass (MIDCAB) is a surgical treatment for coronary heart disease that is a less invasive method of coronary artery bypass surgery (CABG). MIDCAB gains surgical access to the heart with a smaller incision than other types of CABG. MIDCAB is sometimes referred to as "keyhole" heart surgery because the operation is analogous to operating through a keyhole.

Postperfusion syndrome, also known as "pumphead", is a constellation of neurocognitive impairments attributed to cardiopulmonary bypass (CPB) during cardiac surgery. Symptoms of postperfusion syndrome are subtle and include defects associated with attention, concentration, short-term memory, fine motor function, and speed of mental and motor responses. Studies have shown a high incidence of neurocognitive deficit soon after surgery, but the deficits are often transient with no permanent neurological impairment.

<span class="mw-page-title-main">Oxygenator</span> Medical equipment

An oxygenator is a medical device that is capable of exchanging oxygen and carbon dioxide in the blood of human patients during surgical procedures that may necessitate the interruption or cessation of blood flow in the body, a critical organ or great blood vessel. These organs can be the heart, lungs or liver, while the great vessels can be the aorta, pulmonary artery, pulmonary veins or vena cava.

The following outline is provided as an overview of and topical guide to cardiology, the branch of medicine dealing with disorders of the human heart. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in cardiology are called cardiologists.

Cardiothoracic anesthesiology is a subspeciality of the medical practice of anesthesiology, devoted to the preoperative, intraoperative, and postoperative care of adult and pediatric patients undergoing cardiothoracic surgery and related invasive procedures.

Minimally invasive cardiac surgery, encompasses various aspects of cardiac surgical procedures that can be performed with minimally invasive approach either via mini-thoracotomy or mini-sternotomy. MICS CABG or the McGinn technique is heart surgery performed through several small incisions instead of the traditional open-heart surgery that requires a median sternotomy approach. MICS CABG is a beating-heart multi-vessel procedure performed under direct vision through an anterolateral mini-thoracotomy.

Vessel harvesting is a surgical technique that may be used in conjunction with a coronary artery bypass graft (CABG). For patients with coronary artery disease, a vascular bypass may be recommended to reroute blood around blocked arteries to restore and improve blood flow and oxygen to the heart. To create the bypass graft, a surgeon will remove or "harvest" healthy blood vessels from another part of the body, either arteries from an arm or the chest, or veins from a leg. This vessel becomes a graft, with one end attaching to a blood source above and the other end below the blocked area, creating a "conduit" channel or new blood flow connection across the heart.

Robert S. Poston is an American cardiac surgeon at University of Arizona Medical Center most noted for his work in robot-assisted heart surgery and Coronary Artery Bypass Surgery.

<span class="mw-page-title-main">Hybrid cardiac surgery</span>

A hybrid cardiac surgical procedure in a narrow sense is defined as a procedure that combines a conventional, more invasive surgical part with an interventional part, using some sort of catheter-based procedure guided by fluoroscopy imaging in a hybrid operating room (OR) without interruption. The hybrid technique has a reduced risk of surgical complications and has shown decreased recovery time. It can be used to treat numerous heart diseases and conditions and with the increasing complexity of each case, the hybrid surgical technique is becoming more common.

Sotirios Prapas is a Greek cardiac surgeon.

<span class="mw-page-title-main">Anil Bhan</span> Indian cardiologist

Dr. Anil Bhan is the Chairman of Cardiac Surgery Heart Institute, Medanta Hospital, Gurugram, India. He graduated from Medical College Srinagar. He has the largest experience in aortic surgery in India since he has designed and developed more than 50 surgical instruments in the field of cardiac surgery. He was one of the team members to perform the first successful heart transplant in India in1994. He served as a co-founder of Max Heart and Vascular Institute, Saket, New Delhi, Director and Chief Co-Ordinator, Cardio thoracic and Vascular Surgery, MHVI, Saket.Additional Professor, Cardiothoracic Surgery and Vascular Surgery, AIIMS, New Delhi.

John D. Puskas is an American researcher, author, inventor and cardiovascular surgeon. As of 2022, he is Professor, Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, and chairman, Department of Cardiovascular Surgery at Mount Sinai Morningside, Mount Sinai Beth Israel and Mount Sinai West. He holds 11 U.S. patents and co-founded the International Coronary Congress and the International Society for Coronary Artery Surgery. He is credited by ResearchGate with 330 publications and 15,234 citations and as of 2022 Scopus reports an h-index of 62. Puskas is known for advancing coronary artery bypass (CABG) surgery by refining surgical techniques for all-arterial, off-pump CABG and inventing finer instruments to be used for advanced coronary bypass surgical procedures. He is credited with performing the first totally thoracoscopic bilateral pulmonary vein isolation procedure. He is the co-editor of State of the Art Surgical Coronary Revascularization, the first textbook solely devoted to coronary artery surgery.

References

  1. ↑ Postperfusion syndrome
  2. ↑ Zhao, Dong Fang (February 28, 2017). "Coronary Artery Bypass Grafting With and Without Manipulation of the Ascending Aorta: A Network Meta-Analysis". Journal of the American College of Cardiology. 69 (8): 924–936. doi:10.1016/j.jacc.2016.11.071. PMID   28231944.
  3. ↑ Ross, Donald (Summer 2012). "Anaortic Coronary Bypass Surgery". Seminars in Thoracic and Cardiovascular Surgery. 24 (2): 90–92. doi:10.1053/j.semtcvs.2012.04.005. PMID   22920523.
  4. ↑ Misfeld, Martin; Brereton JL; et al. (August 2011). "Neurological complications after off-pump coronary artery grafting with and without aortic manipulation". J. Thorac. Cardiovasc. Surg. 142 (2): e11–e17. doi: 10.1016/j.jtcvs.2010.11.034 . PMID   21281950.
  5. ↑ Cremer, J; Schoettler, J; Thiem, A; Grothusen, C; Hoffmann, G (2011). "The MIDCAB approach in its various dimensions". HSR Proceedings in Intensive Care & Cardiovascular Anesthesia. 3 (4): 249–53. PMC   3563440 . PMID   23440055.
  6. ↑ Purmessur, R; Wijesena, T; Ali, J (31 July 2023). "Minimal-Access Coronary Revascularization: Past, Present, and Future". Journal of Cardiovascular Development and Disease. 10 (8): 326. doi: 10.3390/jcdd10080326 . PMC   10455416 . PMID   37623339.
  7. ↑ http://ajw.asahi.com/article/behind_news/social_affairs/AJ201205230073
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