What Is off-Pump Coronary Artery Bypass?

Off-pump coronary artery bypass is performed without the assistance of a heart-lung machine, so the patient’s heart is beating throughout the procedure. This is also sometimes known as a beating heart surgery, in a reference to the key feature distinguishing it from the more traditional on-pump coronary artery bypass. Approaching the surgery this way can reduce the risk of complications associated with the machine, but the surgeon needs to exercise special care because it is challenging to work safely on a beating heart.

Patients may need this procedure when the coronary arteries that supply blood to the heart are narrowed or blocked and require grafts to move blood around the involved area. This is also referred to as a Coronary Artery Bypass Graft (CABG) surgery. Historically, surgeons put patients on a heart-lung machine so the heart would be perfectly still, keeping the surgical field clean and easy to work in. Advocates for off-pump coronary artery bypass argued that it could lessen potential complications like stroke and hospitalization associated with the machine.

To prepare for the surgery, the patient is placed under anesthesia and receives medications to slow and stabilize the heart rate. While a low heart rate is not safe for the long term, in this surgery it can make it easier for the surgeon to work. The surgical team uses a special tool that attaches to the heart muscle and stabilizes it so the doctor can make an incision to expose the surgical site. Assistants control bleeding so the surgeon can see while making an incision in the vessel, installing a graft, and then closing the site. After the off-pump coronary artery bypass, the patient’s heart rate can be allowed to return to normal.

Studies on off-pump coronary artery bypass suggest it can reduce the incidence of side effects and results in shorter hospitalizations and recovery times for patients. There are some concerns that it is harder to place a graft in a beating heart, just as it is easier to shoot an arrow from the ground than from the back of a galloping horse. Poor graft placement could result in a bad patient outcome, making it important for surgeons to check their work to confirm the heart is in good condition.

If a surgeon feels off-pump coronary artery bypass may be a good option for a patient, it can be discussed in consultations prior to the surgery. Patients may want to ask about the surgeon’s outcome with prior cases, level of experience, and training. General statistics on the hospital should also be available, and may be useful for people making decisions about where they want to receive treatment.