What is off-pump coronary artery bypass graft (CABG) surgery?
This procedure is similar to traditional coronary artery bypass graft (CABG) surgery except your heart is never stopped and you aren’t placed on a heart-lung bypass machine.
The goal of CABG is to restore blood flow that is blocked or limited by coronary arteries, which supply your heart muscle with blood.
With off-pump bypass surgery, your heart is never stopped and surgeons operate on your heart while it continues beating. That’s why this surgery is sometimes called “beating heart” surgery.
Off-pump CABG at The Ohio State University Wexner Medical Center Richard M. Ross Heart Hospital uses the two arteries on either side of the sternum (breastbone) in your chest wall and an artery in the forearm. The surgeon uses these arteries to create bypasses, or grafts, around the blocked arteries in the heart.
It’s a technically challenging procedure, and Ohio State’s expertise and experience continue to lead to positive outcomes for our patients.
You may also see this surgery called anaortic, total arterial, off-pump coronary artery bypass graft surgery (anOPCABG).
What is the difference between on-pump and off-pump CABG?
During traditional on-pump CABG, your heart will be temporarily stopped and you’ll be connected to a heart-lung machine.
The heart-lung machine takes blood out of your body, adds oxygen, removes carbon dioxide, then puts oxygenated blood back into your body — in short, the machine does the work of your heart and lungs.
During off-pump CABG, your heart won’t be stopped and therefore you won’t need to be placed on a heart-lung machine. The surgeon will operate on your heart while it continues beating. This is why this surgery is sometimes called “beating heart” surgery.
Why is an off-pump CABG done?
Like traditional CABG, off-pump CABG surgery is a treatment for coronary artery disease. Before recommending surgery, your doctor may first prescribe medications or advise lifestyle changes to improve your condition.
Additionally, you may be eligible for a nonsurgical procedure called coronary angioplasty.
A successful CABG surgery can improve symptoms of coronary artery disease, reduce the risk of a future heart attack and improve survival.
While it sounds scary to operate on a beating heart, surgeons use a stabilizing device to minimize motion of the beating heart and increase the surgeon’s precision.
Studies have shown fewer complications after off-pump CABG than traditional CABG.
Who is a candidate for off-pump bypass surgery?
If surgery is deemed the best option, your doctor will evaluate you for either traditional CABG or off-pump CABG.
This surgery is a perfect option for those who may have complex diseases and are not good candidates for traditional CABG.
For example, those with atherosclerosis, kidney problems or chronic lung disease are often great candidates for off-pump CABG.
How to prepare for off-pump CABG surgery
Before your surgery, you’ll meet with your surgeon and may have several tests to identify blockages in your arteries.
Once a careful plan is formulated, your surgery will be scheduled.
What happens during off-pump bypass surgery?
During the procedure, your physician will cut open your sternum (breastbone) to pull back your ribs. This gives your surgeon full access to your heart and coronary arteries.
The surgery takes three to four hours, depending on the location and number of blockages in your coronary arteries. The procedure can be used to create as many bypass grafts as needed.
Once the heart is exposed, the surgeon positions a stabilizer device with suction cups onto the heart muscle. This minimizes movement in the area where the first blocked artery is located. The heart continues to pump, and the surgeon is trained to work with the movement.
After sewing one graft onto the first blocked artery, the surgeon repositions the stabilizer on the heart. The surgeon then works on sewing the next bypass graft onto the next blocked artery and keeps doing that until all grafts are completed.
The surgeon tests the grafts with a flow probe to make sure they are working. They place several small tubes in your chest cavity that will come out through an opening in your upper abdomen. The tubes allow extra fluid and any air in your chest to drain out as you’re recovering.
Finally, your surgeon closes the sternum with metal wires and sews up the muscles and skin on your chest.
Recovery from off-pump bypass surgery
After surgery, your health care team will closely monitor your heart rate and other vital signs. You may have a tube in your throat to help you breathe for up to 24 hours after the surgery.
You’re likely to have some pain, and doctors can prescribe medication to keep your pain manageable.
As soon as you’re feeling up to it, your health care team will work to get you up and sitting in a chair.
Breathing exercises may also help avoid fluid buildup in your lungs.
You should expect to stay in the hospital for several days.
Once home, you may need help for the first several days. About two weeks after surgery, your stitches and staples will be removed.
It may take several weeks before you fully recover from the surgery. Your doctor may recommend participation in a cardiac rehabilitation program to help regain your strength.
Don’t drive until your doctor says it’s safe to do so.
Avoid heavy lifting for several weeks.
What are the risks of an off-pump bypass surgery?
Off-pump CABG is an open-heart surgery and considered a major operation. Like any surgery, there are some risks, including:
- Bleeding
- Blood clots – which can lead to stroke or heart attack
- Infection
- Irregular heart beat
- Kidney failure
What are the benefits of off-pump bypass surgery?
The anaortic off-pump CABG procedure has some important benefits over traditional CABG surgery. Many are due to not touching the aorta during the surgery. With traditional CABG, the aorta is manipulated or clamped. There is a risk this can cause a small blood clot to form in the aorta after surgery. By not touching the aorta, the off-pump approach helps prevent strokes and other organ damage due to dangerous clots circulating in the body.
It’s a safer option for people who are elderly or have other health conditions that would make it difficult to recover from complications of surgery.
Benefits of an off-pump CABG include:
- Fewer complications, including greatly reduced numbers of stroke, renal (kidney) failure, bleeding complications and atrial fibrillation (irregular heart beat) in the months following surgery
- 50% reduction in death following surgery (operative mortality)
- A shorter stay in the intensive care unit following surgery
- Reduced plaque buildup and greater durability of arterial grafts as compared to veins used as bypass grafts with traditional CABG
- Greater long-term survival with total-arterial grafting as opposed to the use of vein grafts — grafts created from arteries have proven to be the most durable and long-lasting blood vessels to use as bypasses
Why choose Ohio State for an off-pump CABG?
We’re the only hospital in central Ohio that performs off-pump CABG. Our surgeons have the expertise and experience you can trust to give you confidence in positive outcomes.
If you’re a candidate for off-pump CABG, we know this procedure offers fewer risks of complications.
And if you’re not a candidate, our surgeons can help guide you through the traditional CABG procedure or any other surgery to fix your heart issues.
We know you didn’t choose to have heart problems, but Ohio State is the clear choice for your care.