Beating heart 'off-pump' coronary artery bypass surgery
Professor Gianni Angelini, Professor Raimondo Ascione and
colleagues in the Bristol Heart Institute, University of Bristol
and UH Bristol
Coronary artery bypass grafting (CABG) is carried out to improve
the blood supply to the heart in patients with severe coronary
heart disease. Conventional CABG surgery involves stopping the
heart (cardioplegic arrest) and the use of a cardiopulmonary bypass
pump (CPB), and is being done in an increasingly high-risk
population (caused by increasing age, smoking, diabetes,
hypertension and high cholesterol). The use of cardioplegic arrest
and CPB in these high-risk patients is associated with significant
in-hospital mortality and morbidity - largely due to the fact that
the heart has to be stopped during surgery. To overcome this
problem, researchers have pioneered the novel technique of off-pump
coronary artery bypass surgery, avoiding both stopping the heart
and use of CPB. This means that patients have bypass surgery
whilst their hearts are still beating - just the small area which
is being operated on at the time is kept still - and there is no
need to circulate the blood using a machine. Over ten
clinical trials and several large cohort studies have now been
completed to assess the impact of this technique on high-risk
patients.
The results have shown that off pump surgery is as safe as the
conventional coronary artery bypass grafting (CABG) technique. Most
importantly, however, off-pump surgery significantly reduces the
risk of post-operative complications, and reduces morbidity and
mortality. It also reduces the time patients spend in intensive
care, and overall in hospital. In 2011 (the last year for which
data are available), 20% (one in five) of CABG operations in the UK
were carried out with the OPCAB technique and it has had
significant take-up overseas (e.g. 18% of CABG operations in the
USA and 21% in EU). NICE (the National Institute for Health and
Care Excellence) has recommended the use of OPCAB surgery.
Over the years, an effective programme of training in OPCAB
surgery has been implemented at the Bristol Heart Institute (BHI).
Once surgeons are trained and accustomed to doing it, they are
reluctant to go back to CABG-CPB because they are more comfortable
with the OPCAB technique and its reduction in early post-operative
morbidity and use of resources. Consultants trained in beating
heart coronary surgery at BHI and now performing this surgery
elsewhere include six in the UK outside Bristol, and six
internationally. The usage of the OPCAB technique is expected to
more than double in the US and worldwide in the next few years.
The usage of the OPCAB technique has had a
profound impact post-operative complications that patients
experience, and on hospital resources and cost, with a 25% saving
per patient.
Further information:
http://www.bristol.ac.uk/news/2006/11570409967.html
http://www.bristol.ac.uk/news/2002/angelini.htm
http://www.bristol.ac.uk/bhi/
