What is Beating Heart Surgery?

Beating heart surgery is a cardiac surgery that was popularized in the 1990s as an alternative to surgeries where the heart is stopped and bypass is used to provide needed circulation of blood. This surgery has, thus far, fairly limited applications in all the possible heart surgeries that can be performed. Yet its popularity rose because it avoided some of the known complications of using bypass and stopping the heart, such as potential for cell death in the brain. Initial fervor over this surgical method has died down somewhat because there are risks and benefits of beating heart surgery or off-pump surgery that are comparable to traditional or on-pump procedures.

Original heart surgeries were unsuccessfully attempted on the beating heart, and a huge discovery in cardiothoracic medicine was development of bypass techniques and use of hypothermia to stop and protect the heart. Certain heart conditions were irreparable without the pioneering efforts of several doctors throughout the world in the mid-twentieth century. Complicated heart defects can now be repaired, and surgeries like cardiopulmonary bypass have become much easier when surgeons had a more visible, bloodless field on which to work, and a stable, unmoving heart that could be easily manipulated.

There were definite disadvantages to heart-lung bypass. Among these were the potential for brain cell death or stroke during surgery. The former is a particular concern in repairs of congenital heart defects in children. This led some doctors to look for techniques that would allow the heart to continue beating, but still, some stabilization of the heart was needed so that surgery could be performed. In the late 20th century, several stabilization devices were invented that could be placed on the heart to minimize movement during beating, and these allowed surgeons to contemplate the possibility of repairing a variety of heart problems with beating heart surgery.

The principal beating heart surgery types include bypass surgeries, repairs of minor defects in children’s hearts, and placement of shunts for palliation. Some of these surgeries are minimally invasive and may use smaller incisions, thus cutting down on recovery time. Review of these surgeries, which have been performed since the 1990s, suggest they are about equal with on-pump procedures, but they may actually, in the case of bypass, not be any better when it comes to protecting the brain, and repairs may not be as stable.

There is now a schism in the world of cardiac surgery as to whether beating heart surgery is appropriate. It seems useful in elderly patients, and for those at greater risk for complications from bypass. Extensive studies suggest mortality rates are slightly higher, though recovery from bypass surgeries may be faster. Unfortunately, it isn’t the miracle cure that surgeons initially hoped.

Patients requiring heart surgery are advised to get education on risks versus benefits of on and off-pump surgeries. There can be legitimate reasons to choose one over the other. With doctors, patients can work on determining best choice depending on individual circumstances. Sometimes that choice is a beating heart surgery and other times the best option is an on-pump procedure.