Off Pump Coronary Artery Bypass Grafting (OPCAB)

If conservative treatment options for coronary artery disease are unsuccessful and you continue to have chest pain or are at risk of having a heart attack, your cardiologist may refer you to a cardiothoracic surgeon for coronary artery bypass surgery. One type of bypass surgery that may be recommended is called Off-Pump Coronary Artery Bypass.

Off-Pump Coronary Artery Bypass (OPCAB), also called “Beating Heart” surgery, is an operation to treat narrowed or blocked coronary arteries. This is accomplished by going around or “bypassing” the blocked artery with a healthy vessel called a “graft” that is taken from the leg, arm or chest. The graft will now carry the blood around the blockage to improve the blood flow to the heart muscle.

Traditionally, coronary artery bypass surgery is performed with the heart stopped and the patient on a heart-lung bypass pump. The pump’s function is to oxygenate and circulate the blood while the heart is stopped. This is referred to as cardiopulmonary bypass or CPB. Because there are certain risks associated with CPB, specially trained cardiothoracic surgeons are now performing bypass surgery “off pump”, meaning without the bypass machine.

OPCAB surgery is open-heart surgery performed without the patient on cardiopulmonary bypass (CPB) and with the heart still beating. “Open Heart Surgery” is a common term used when referring to Coronary Artery Bypass surgery. Many people believe the heart is “opened up” in “open heart surgery”. However, this is not the case. The name actually refers to the fact that the surgery is performed through a large, open, chest incision. Since the surgery is actually performed on the vessels on the outside of the heart there is no need to cut the heart open.

Some surgeons are performing minimally invasive coronary bypass surgery (MICABG) through tiny incisions called portals enabling a quicker recovery time with decreased trauma to the tissues and bones.

Procedure

The goal of Off-Pump Coronary Artery Bypass surgery is:

• To relieve symptoms of CAD
• Improve blood flow to the heart
• To lengthen the patient’s life

Off-Pump Coronary Bypass surgery is performed by cardiothoracic surgeons in the operating room with the patient under general anaesthesia. The operation usually takes about 3 hours but may be longer depending on the number of bypasses to be done. During OPCAB, the patient is placed lying on their back on the operating table. The chest and graft area are shaved and scrubbed with antiseptic. You will be given a general anaesthetic so you will be asleep and not feel any pain.

What is Off-Pump Coronary Artery Bypass Surgery All About?

Your surgeon will make a long incision down the middle of your chest bone (sternum). This is called a median sternotomy. Special instruments called retractors are used to spread the ribs apart so the surgeon can access the heart.

At the same time, another surgeon will “harvest” (remove) a vessel from either your arm (radial artery) or leg (long saphenous vein) to be used as the graft. This may be done through a large “open” incision or endoscopically through a much smaller incision. Your surgeon may choose to use an artery in the chest called the internal thoracic artery. In this case, you will not have a “graft site” incision on your arm or leg unless you are having multiple bypasses performed.

With the heart beating, your surgeon will stabilise the heart muscle on either side of the blockage with a special device. This enables the surgeon to work on a small area with minimal movement but with the heart still beating and pumping blood throughout the body. If a leg or arm graft is used, the surgeon then attaches one end of the graft with fine sutures to the Aorta.

The other end of the graft is then attached to the coronary artery beyond the blockage. This enables the blood to “bypass” the blockage and flow freely to the heart muscle. If the internal thoracic artery is used, your surgeon will redirect the artery by detaching one end of it and reattaching it below the blockage on the coronary artery.

Once your surgeon has completed the number of bypasses needed the surgeon will use wires to reattach the sternum and suture the incision closed, usually with dissolvable sutures.