You've probably heard of heart bypass surgery, right? Maybe someone in your family or a friend has had to undergo this type of surgery. Usually, when we talk about bypass surgery, we think of a major operation that involves stopping the heart and connecting it to a machine. But did you know that there is also a bypass surgery that can be done without stopping the heart, that is, while the heart is still beating? That's what we call "Off-pump" bypass surgery, or "Beating Heart Surgery." Let's talk about this in simple terms today.
Okay, what is this bypass surgery that is performed without stopping the heart?
Simply put, this is a type of coronary artery bypass graft (CABG). In bypass surgery, a new artery is created to bypass a blocked artery (coronary artery) that supplies blood to the heart. This is done using a healthy blood vessel (graft) taken from another part of the body, for example, the leg or chest.
Imagine, there is a lot of traffic on a road, so cars are not moving. Then we build a bypass road to avoid that traffic. This allows blood to flow properly to the heart again.
In traditional bypass surgery (On-pump CABG) , surgeons stop the patient's heart completely. Then, the work of the heart and lungs is done by a special machine until the surgery is complete. This is called a cardiopulmonary bypass machine. This machine takes blood from the body, adds oxygen to it, removes carbon dioxide, and pumps clean blood back into the body.
But in off-pump CABG, the heart-lung machine is not used. The surgeon performs the surgery while your heart is beating . That's why it's called "Beating Heart" surgery.
Who needs this surgery?
This surgery is mainly performed on patients with coronary artery disease (CAD). In CAD, fatty deposits (plaque) build up inside the blood vessels of the heart, narrowing the blood flow. This can cause symptoms such as chest pain and shortness of breath. If these vessels become completely blocked, the risk of a heart attack is very high.
When the disease becomes too severe to be controlled with lifestyle changes, medications, and other treatments, doctors recommend bypass surgery. This surgery can reduce symptoms, reduce the risk of heart attacks, and increase survival. So, for some patients who decide to have bypass surgery, this off-pump procedure may be a good option.
How do you prepare before surgery?
If you are scheduled to have this surgery, your medical team will give you instructions on how to prepare. These instructions may include:
- If you smoke, stop immediately.
- Your doctor will advise you to temporarily stop taking some medications, especially anticoagulants.
- The day before the surgery, you will be told not to eat or drink anything from midnight.
In addition, you may also have several tests to see if you are in a healthy condition for surgery:
- Blood tests
- Chest X-ray examination
- Echocardiogram (Echo)
- ECG test (Electrocardiogram)
- Specialized tests like Nuclear Cardiac Stress Test
What happens during the surgery?
Your surgeon will explain to you what will happen during the surgery. Here are some things that will usually happen:
1. Anesthesia: You are put completely to sleep and anesthetized so that you don't feel any pain.
2. Graft Harvesting: The piece of healthy blood vessel needed for the bypass is taken from your leg, arm, or inner chest.
3. Incision: An incision is made in the middle of the chest, carefully moving the breastbone to either side. Sometimes, depending on the location of the blocked duct, a small incision may be made between the ribs on the left side of the chest.
4. Stabilizing the heart: Since the surgery is performed while the heart is beating, a special device called a ``Stabilizer`` is used to hold the small area of the heart that is being operated on so that it does not move. This allows the surgeon to remain still and perform the operation clearly.
5. Bypass: Blood flow through the blocked artery is temporarily stopped, and one end of the previously taken healthy blood vessel is connected to the aorta and the other end to the coronary artery below the blockage. This creates the new bypass.
6. Closure: When the work is complete, the blood flow is temporarily stopped, the chest bone is reattached with special wires, and the skin is sutured and closed.
Is traditional surgery (On-pump) or this new method (Off-pump) better?
Research is still ongoing to determine which of these two methods is better in the long term. Your surgeon will discuss with you which method is best for you. Let's look at the main differences and pros and cons of these two methods.
| Specialty | Traditional Method (On-Pump) | "Beating Heart" Method (Off-Pump) |
|---|---|---|
| Heart condition | The heart stops during surgery. | The surgery is performed while the heart is beating. |
| Heart-lung machine | Using. | Not used. |
| The advantage for the surgeon | The surgery can be performed clearly because there is no movement or blood. | Technically more challenging. Requires special training. |
| Potential benefits for the patient | Standard, commonly used method. | Smaller incision, shorter hospital stay, faster recovery. May reduce the risk of complications such as memory loss, stroke, and infection. |
The most important thing is that not everyone can do this non-heart-stopping surgery. Also, to perform this surgery, you need a surgeon with special experience in it.
What are the risks of this surgery?
As with any major surgery, there are some risks involved. However, most people have successful outcomes. Possible risks include:
- Bleeding
- Blood clots (which can cause stroke or heart attack)
- Complications due to anesthesia
- Infections
- Irregular heartbeat (Arrhythmia)
- Kidney Failure
How long does it take to recover?
The recovery time after surgery depends on several factors, such as your age, overall health, and the size of the incision. It usually goes like this:
- You can start taking fluids and 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.
- It is definitely important to have someone to help you in the first few days after you go home.
- The stitches will be removed in about ten weeks.
- It's best not to lift any weights for a few weeks.
- It may take several weeks or longer to fully recover.
- Doctors will advise you to participate in a cardiac rehabilitation program to rebuild your strength.
In what cases should you seek immediate medical advice?
During your recovery, you will need to visit the clinic on scheduled days and see your doctor. However, if you develop any of the following symptoms, call your doctor immediately or go to the Emergency Department (ETU) of the nearest hospital.
| Symptoms to watch out for |
|---|
| Chest pain or stomach pain that doesn't go away. |
| Feeling cold or sweating excessively. |
| A sensation of the breastbone moving or making a "clicking" sound. |
| Fast or irregular heartbeat. |
| Nausea or vomiting. |
| Difficulty breathing. |
| Signs of infection (fever, redness near the incision, swelling, pus drainage). |
| Sudden weight gain (more than 2 kg per week). |
Take-Home Message
- Off-pump bypass surgery is a special type of bypass surgery that is performed on a beating heart without stopping the heart.
- Some patients may benefit from this method, such as reduced hospital stay, faster recovery, and a reduced risk of some complications.
- This surgery is not suitable for every patient. It is important to determine whether the patient is suitable for it and whether the surgeon has special training for it.
- If you need bypass surgery, discuss with your cardiothoracic surgeon whether the traditional method (on-pump) or this method (off-pump) is best for you.
- Following medical instructions carefully after surgery is essential for a quick and successful recovery.
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