Beating Heart Surgery – A Primer

Normal Or Clear Artery Plaque Forming In Occluded Artery Progressively Blocked Artery

The heart is a muscular organ that continuously pumps blood rich with oxygen through the entire body. In order to function properly, the heart muscle itself must also receive oxygen-rich blood. This blood is delivered through the blood vessels on the surface of the heart called coronary arteries. The coronary arteries can become blocked by a build-up of cholesterol fats. This build-up is called "atherosclerotic plaque" – often simply referred to as "plaque." Plaque deposits can make the arteries stiff and irregular, resulting in "hardening of the arteries."

Coronary artery disease can appear as a single blockage or multiple blockages, and can vary in severity. The blockages in the coronary arteries reduce the blood supply to the heart, which in turn reduces the amount of oxygen that the heart muscle receives.  The heart muscle is quite sensitive to oxygen levels and does not properly function when the arteries become blocked.

Internal Mammary Artery Graft Bypass

Radial Artery or Saphenous Vein Graft Bypass

Coronary artery bypass surgery restores the blood flow to the portion of the heart beyond the blockage.  In the past when this was done a heart lung machine was used to stop the heart so surgery could be done.  Today, Dr. Gibson and Dr. Gomez keep the heart beating with the use of a device called the octopus made by Medtronic.  This stabilizing device immobilizes a small section of the heart that needs the bypass graft while the rest of the heart muscle continues to beat and pump blood to the body. 

The potential advantages of beating heart surgery include shorter hospital stay, faster recovery time for the patients, less damage to blood cells sometimes caused by use of the heart lung machine.  The time the patient spends in the operating room is lessened as well as the time spent on a breathing machine (ventilator).  Most patients have better outcomes and less risk of stroke, pneumonia or kidney problems.

If you are in need of heart surgeon and think you might be a candidate for “Beating Heart Surgery” contact our office for an appointment. 

How Beating Heart Bypass is Performed

An incision is made in the chest as the heart continues to beat. Positioning and stabilization instruments lift and hold the heart and then stabilize a portion of the heart’s surface where the bypass graft will be sutured in place, all as the heart continues to beat. The Medtronic Octopus® System II includes the Octopus®4 Tissue Stabilizer and the Starfish™2 Heart Positioner. Using gentle suction only, they address the primary challenge in Beating Heart bypass surgery, making it possible to access all surfaces of the heart while reducing motion of the small area of surface tissue where the surgeon is sewing the bypass graft.

Potential Patient Benefits of Beating Heart Bypass Surgery

A stabilization system makes it possible to avoid use of the heart-lung machine by enabling the surgeon to carefully work on the patient’s heart while it continues to beat. Beating Heart bypass surgery has the same beneficial results as conventional bypass surgery with the heart-lung machine – restoring adequate blood flow and normal delivery of oxygen and nutrients to the heart. Clinical studies suggest that Beating Heart bypass surgery may also have the following advantages:

• Shorter length of hospital stay: Patients are often discharged from the hospital more quickly after beating heart surgery. One report from the medical literature notes a 32% shorter length of hospital stay for off-pump patients, a statistically significant difference.
• Fewer blood transfusion requirements/less use of banked blood or blood products: Avoiding the heart lung machine has been shown to reduce the use of blood products. Fewer patients require blood transfusions when undergoing Beating Heart surgery. These are important considerations in areas where banked blood may be in short supply or where transmission of bloodborne diseases is a concern.
• Potential avoidance of neurocognitive decline: A study in the New England Journal of Medicine found measurable and persistent neurocognitive decline (memory loss, decline in thinking skills) in patients who had conventional “on-pump” heart bypass surgery utilizing the heart-lung machine. In two separate studies, postoperative neurocognitive function test scores were significantly better in groups of Beating Heart surgery patients than in groups of patients who underwent conventional procedures.
• Available to more patients: Some patients are poor candidates for traditional bypass surgery techniques because of preexisting medical conditions (diabetes, renal problems, patient history of stroke or heart attack, etc.), or the fact that they are very ill. The medical literature refers to these patients as “high risk.” Beating Heart surgery, which avoids the heart-lung machine, may make it possible for high-risk patients to undergo bypass surgery. Arom, et. al., found that off-pump CABG carries a significantly lower mortality rate in the high risk population than conventional CABG.

*On occasion a surgeon may convert to use of the heart-lung machine during the procedure if for some reason the patient’s condition becomes unexpectedly unstable.

Off-pump Bypass Surgery - Introduction

Off-pump Bypass Surgery - Frequently Asked Questions