Watch the Video: Off-Pump Coronary Artery Bypass Grafting

Coronary arteries supply the heart with oxygen-rich blood. Coronary artery bypass grafting, often referred to as CABG, is performed for patients who have narrowings or blockages of the coronary arteries. The blockages or narrowings of the coronary arteries is known as coronary artery disease and is secondary to a disease process known as arteriosclerosis, commonly referred to as "hardening of the arteries".

In performing a coronary artery bypass, the surgeon utilizes a piece of vein from the patient's leg or an artery located on the inside of the chest to create an alternative pathway for the oxygen-rich blood to enter the narrowed or blocked artery so that this blood can reach the heart muscle. Hence the name coronary artery bypass. The new graft helps blood "bypass" the narrowing or blockage.

Traditionally, coronary artery bypass grafting operations are done using the heart-lung machine, which is commonly referred to as the "pump". The heart-lung machine is very safe and the majority of open heart operations done today cannot be performed without its use. The operation is said to be done using cardio-pulmonary bypass, because the heart-lung machine does the work of the patient's heart and lungs.

Generally, when a CABG is done using the heart-lung machine, the heart is stopped with medications and the pump does the work of the heart and lungs while the surgeon performs the bypasses. This allows the surgeon to position the heart as needed, to accurately identify the arteries and perform the bypass while the heart is quiet. At the completion of the bypass, the surgeon allows the heart to start beating and weans the patient off the pump as the heart and lungs resume their job.

Despite the safety of the "pump", there are numerous physiologic consequences of being "on pump". Most of these consequences are minor and easy to treat, but in some instances they can be significant. In the last few years surgeons and medical device companies have developed technology and techniques to perform coronary artery bypass grafting without the heart-lung machine, aka "the pump", hence the name "Off-Pump Coronary Artery Bypass Grafting". Off-pump coronary bypass grafting is usually referred to as OPCAB or off-pump CABG.

During an OPCAB, the surgeon allows the heart and lungs to continue to work in their usual fashion while the bypass grafts are completed. The devices used "stabilize" and help position the heart so that the surgeon can perform the bypasses. In the video, the heart is beating but the area that the surgeon is working on is relatively still, but still moving.

One potential advantage of off-pump coronary artery bypass grafting is that the patient avoids the potential consequences or side effects of being on cardio-pulmonary bypass (being done "on pump"). There is some evidence that doing the surgery "off-pump" shortens the recovery time for the patient and shortens the hospital stay. Multiple bypasses can be performed using the current technology and techniques, but your surgeon will decide whether on-pump or off-pump is best for the patient.

Not all patients will tolerate the lifting of their heart, or the maneuvers needed to be done safely without the use of the heart-lung machine. Patients with poorly functioning hearts, emergency or unstable patients, patients with small and diffusely narrowed arteries, or with most of the required bypasses on the back of the heart, may not be candidates for off-pump bypass surgery.