What is CABG surgery on a beating heart?

Coronary arteries supply your heart muscle with blood. If you have narrowed or blocked areas in your coronary arteries, you need treatment to restore normal blood flow. One effective treatment is surgery to bypass the clogged areas. This kind of surgery is called coronary artery bypass graft (CABG) surgery.

One type of CABG surgery offered at Ohio State’s 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 grafts, or bypasses, around the blocked arteries in the heart.

This type of CABG surgery is called “anaortic, total arterial, off-pump coronary bypass graft surgery”—or, anOPCABG. It’s also called “aortic no-touch” beating heart bypass surgery. It’s called this because the heart continues beating throughout the surgery and the aorta is not touched.

AnOPCABG surgery is performed frequently throughout Asia and Europe and is gaining greater interest in the U.S. It’s technically challenging, and Ohio State’s expertise and high-volume experience contribute to positive outcomes for our patients.

What is anOPCABG surgery?

Here is a breakdown of the key features of the surgery:

“Anaortic” means the procedure is performed without manipulating or clamping the aorta. The aorta is the major blood vessel that carries blood from your heart to other parts of your body. Not clamping the aorta helps prevent complications, such as strokes caused by material from within the aorta being dislodged and going to the brain.

“Coronary artery bypass graft” refers to using grafts to detour around clogged areas in the coronary arteries.

“Total arterial” refers to the types of grafts used. The two internal mammary arteries in the chest and a radial artery in each forearm are preferred. They are the most durable and long-lasting blood vessels to use as bypasses around the blocked portion of the coronary artery.

“Off-pump” indicates that your heart beats normally throughout the procedure, without help from a heart-lung machine. The heart-lung machine is used in many traditional CABG surgeries to do the work of the heart and lungs during open-heart surgery.

What happens during 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.

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. He or she places 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.

Read more about the recovery process following surgery.

Benefits of anOPCABG Surgery

The anOPCBG 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. This can cause a small blood clot to form in the aorta after surgery. By not touching the aorta, the anOPCABG 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 anOPCABG 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 operative mortality (death following surgery)
  • 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
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