Beating Heart Surgery – A Primer

Off-Pump Bypass Surgery

The heart is a muscular organ that takes in oxygenated blood from the lungs and pumps it through the body. The blood then travels through the body via blood vessels called coronary arteries. When a buildup of fat, cholesterol, calcium and other elements form, this condition is known as atherosclerotic plaque or heart disease. Hardening of the arteries occurs as this calcified substance fills the arteries and makes them stiff and irregular and difficult for the blood to flow through.

Damage from this condition varies as the heart is sensitive to oxygen levels and does not function well when the arteries are blocked. While hardening of the arteries can cause strain on the heart, an even more dangerous prospect exists when plaque breaks off and cuts off the flow completely resulting in a heart attack.

Coronary artery bypass surgery uses a vein or artery from another part of the body to bypass the blocked artery. Traditional bypass surgery requires stopping the heart and diverting the heart’s function to a heart-lung machine. Extensive research has been done on the potential damage caused to patients who undergo traditional bypass surgery, especially those who are high-risk.

At International Robotic Surgery Center for the Heart and Chest, Dr. Miguel Gomez keeps the heart beating on its own using a stabilizing device. This device immobilizes the small section of the heart that needs the bypass while the rest of the heart continues to beat and pump blood to the body. This is known as off-pump or beating heart surgery.

The potential advantages of off-pump or beating heart surgery include:

• a shorter hospital stay
• faster recovery time
• less damage to blood cells sometimes caused by use of the heart lung machine
• less time in the operating room
• less time on a breathing machine (ventilator)
• lower risk of stroke, pneumonia or kidney problems.

Benefits of Beating Heart Bypass Surgery

Some of the benefits of beating heart surgery that have been recorded in research and clinical trials include:

• Shorter Length of Hospital Stay – Patients are often discharged from the hospital as much as 30 percent more quickly after off-pump or beating heart surgery.
• Reduced Need for Banked Blood – Avoiding the heart lung machine has been shown to reduce the use of blood products. Fewer patients require blood transfusions when undergoing off-pump or beating heart surgery. This is especially important when banked blood may be in short supply or where transmission of blood-borne diseases is a concern.
• Reduced Risk of Neurocognitive Decline – A study in the New England Journal of Medicine found measurable and persistent neurocognitive decline (memory loss, decline in thinking skills) in patients who had conventional on-pump heart bypass surgery. In two separate studies, postoperative neurocognitive function test scores were significantly better in groups of off-pump or beating heart surgery patients than in groups of patients who underwent conventional procedures.
• Available to More Patients – Some patients have preexisting conditions that make them poor candidates for traditional bypass surgery. This includes patients with diabetes, renal problems, and patient with history of stroke or heart attack. Off-pump or beating heart surgery makes it possible for some of these high-risk patients to undergo bypass surgery.

International Robotic Surgery Center for the Heart and Chest performs most bypass surgeries off-pump as compared to the national average of 10-15 percent. There are occasions when a surgeon may convert to use of the heart-lung machine during the procedure if the patient’s condition becomes unexpectedly unstable.

Off-pump Bypass Surgery – Introduction
Off-pump Bypass Surgery – Frequently Asked Questions

If you are in need of a heart surgeon and think you might be a candidate for off-pump or beating heart surgery, contact our office for an appointment.