Let's learn everything about Off-Pump Bypass Surgery!

It's normal to feel a little scared when your doctor tells you or someone you know that you need bypass surgery. That fear increases even more when you hear that "the heart will be stopped and connected to a machine." But did you know that there is a special method that can be used to perform this surgery without stopping the heart, that is, while the heart is still beating? That's what we're going to talk about today, called 'Off-Pump Bypass Surgery.'

What is Off-Pump Bypass Surgery?

Simply put, this is also a type of bypass surgery (Coronary Artery Bypass Graft - CABG) that creates a new path around a blocked blood vessel in the heart. In traditional bypass surgery (On-Pump CABG), the surgeon temporarily stops the patient's heart while performing the surgery. At that time, the work of the heart and lungs is done by a special machine called a 'Cardiopulmonary Bypass Machine'. This machine takes blood from the body, adds oxygen to it, removes carbon dioxide, and returns it to the body.

But in this 'Off-Pump' surgery, the heart is not stopped. The surgeon performs this surgery while the heart is beating. That's why it is also called "Beating Heart Surgery."

Who needs this surgery?

This surgery is mainly performed on people with coronary artery disease (CAD), a leading cause of heart attack.

Think of the small arteries that supply blood to our hearts as roads. In CAD, the inside of these roads becomes clogged with fat and cholesterol (called plaque). This prevents the heart from getting the blood it needs, causing symptoms like chest pain and shortness of breath . If this blockage becomes complete, a heart attack occurs.

A doctor usually recommends bypass surgery when lifestyle changes, medications, and other treatments fail to control the condition. In such cases, 'Off-Pump' surgery can be a good option for some patients.

How to prepare for surgery?

Your surgical team will give you all the instructions you need before the surgery. They will usually say things like:

• If you smoke, stop it completely.
• You may be asked to temporarily stop some of the medications you are taking, especially anticoagulants.
• You will be advised not to eat or drink anything from midnight on the day of surgery.

What tests are done before surgery?

The doctor will order several tests to make sure you are healthy enough to undergo surgery.

• Blood tests
• Chest X-ray
• Echocardiogram (Echo)
• ECG (Electrocardiogram - EKG)
• Specialized tests such as the nuclear cardiac stress test.

What happens during the surgery?

The surgery takes several hours. The surgeon will explain to you in advance what will happen. These are the steps that usually occur.

1. First, you will be anesthetized and put to sleep completely. So you won't feel any pain.

2. Next, a healthy blood vessel (graft) is removed from another part of your body, for example, your leg or chest wall . This blood vessel is used to create a new path to the blocked area.

3. Then, the skin is cut in the middle of the chest, and the breastbone is cut on both sides, reaching the heart.

4. Since the heart is beating, a special device (stabilizer) is used to reduce its movement, and only the area where the surgery is performed is stabilized so that it does not move.

5. Temporarily stops blood flow in the blocked blood vessel.

6. One end of the previously removed healthy blood vessel is connected to the main blood vessel of the heart (the aorta), and the other end is connected to the blocked area below. This is like creating a bypass to bypass a blocked road.

7. After the new pathway is created, blood flow is restored. The blood now bypasses the blockage and travels along the new pathway.

8. Finally, the breastbone is reattached with wire-like materials and the skin is sutured closed.

Which of the two methods is better?

Research is still ongoing on whether on-pump or off-pump surgery is better. Your surgeon will decide which method is best for you. Let's look at the advantages and differences between these two methods.

What are the risks of this surgery?

As with any major surgery, there are some risks involved. But most people recover successfully. Here are some of the possible complications:

• Excessive bleeding.
• Blood clots (which can cause stroke or heart attack).
• Complications due to anesthesia.
• Infectious conditions.
• Irregular heart rhythms.
• Kidney failure.

How long does it take to recover?

The recovery time depends on your age, overall health, and any complications that arise after surgery. In general, the recovery process looks like this.

• You can start drinking fluids and eating small amounts of food on the same day or the next day after surgery.
• Within the first day or two, you will be able to sit in a chair with help and walk a little.
• You have to stay in the hospital for a few days.
• You will need someone to help you for the first few days after you go home from the hospital.
• The stitches will be removed in about a week or ten.
• You should avoid lifting weights for a few weeks .
• It may take several weeks or longer to fully recover.
• Your doctor will advise you to participate in a cardiac rehabilitation program to help rebuild your strength.

What are the signs that you should see a doctor immediately?

You will be given a date to see your doctor during your recovery. However, if you develop any of the following symptoms, you should seek medical advice immediately . Alternatively, go to the Emergency Department (ETU) of the nearest hospital.

• Persistent chest pain or stomach pain.
• Feeling cold or sweating excessively.
• If your breastbone feels like it's moving or making a 'clicking' sound.
• Heart rate that is too fast or irregular.
• Nausea or vomiting.
• Difficulty breathing.
• Signs of infection, such as redness, swelling, pus oozing from the suture site, or fever.
• Sudden weight gain of more than 2-3 kg within a week.