Our Summary

This research paper is examining two types of heart bypass surgery: off-pump coronary artery bypass (OPCAB) and on-pump coronary artery bypass (ONCAB). The review found that OPCAB surgery has some downsides compared to ONCAB. For example, patients who have OPCAB surgery tend to need more follow-up surgeries, experience more heart-related problems, and don’t have as good long-term outcomes. OPCAB surgery also doesn’t prevent kidney problems after surgery and can end up costing more if the surgeon has to switch to the ONCAB method during the operation. However, if the surgeon uses multiple arterial grafts and can do a complete revascularization (which means restoring normal blood flow to the heart), the results of OPCAB surgery can be just as good as ONCAB. Therefore, the researchers conclude that OPCAB surgery should only be done by surgeons who are very experienced with this method and who can achieve a complete revascularization.

FAQs

  1. What is the difference between off-pump coronary artery bypass (OPCAB) surgery and on-pump coronary artery bypass (ONCAB) surgery?
  2. What are the potential downsides of OPCAB as compared to ONCAB?
  3. When is OPCAB recommended over ONCAB according to the review?

Doctor’s Tip

One helpful tip that a doctor might tell a patient about coronary artery bypass surgery is to make sure they are being treated by a surgeon who is experienced in the specific technique being used, whether it is off-pump (OPCAB) or on-pump (ONCAB) surgery. It is also important for the patient to understand that a complete revascularization is crucial for optimal long-term outcomes, and that using multiple arterial grafts can improve the success of the procedure. Additionally, the patient should be aware that OPCAB may not always be the best option and that outcomes can vary depending on individual circumstances.

Suitable For

Patients who are typically recommended for coronary artery bypass surgery include those with:

  • Severe coronary artery disease that cannot be effectively treated with medication or less invasive procedures such as angioplasty or stenting
  • Significant blockages in multiple coronary arteries
  • Left main coronary artery disease
  • Severe angina that is not well controlled with medication
  • High-risk patients who may not tolerate the stress of on-pump surgery

It is important for patients to be evaluated by a cardiac surgeon and cardiologist to determine the best treatment option for their specific condition.

Timeline

  • Before coronary artery bypass surgery:
  1. Patient undergoes diagnostic tests such as angiography to confirm the need for revascularization.
  2. Patient may undergo lifestyle changes, medication management, and other non-surgical interventions to manage symptoms and improve overall health.
  3. Patient meets with a cardiac surgeon to discuss the procedure, risks, and potential outcomes.
  4. Patient may undergo pre-operative testing and preparation, such as blood tests, imaging studies, and medication adjustments.
  • During coronary artery bypass surgery:
  1. Patient is placed under general anesthesia.
  2. Surgeon makes an incision in the chest to access the heart and graft blood vessels.
  3. Cardiopulmonary bypass machine may be used to support circulation during surgery.
  4. Surgeon bypasses blocked or narrowed coronary arteries using grafts from other blood vessels in the body.
  5. Surgery typically takes several hours to complete.
  • After coronary artery bypass surgery:
  1. Patient is moved to the intensive care unit for monitoring and recovery.
  2. Patient may experience pain, discomfort, and fatigue in the days following surgery.
  3. Patient undergoes physical therapy and rehabilitation to regain strength and mobility.
  4. Patient may need to make lifestyle changes, such as diet and exercise, to improve heart health.
  5. Patient follows up with their cardiac surgeon and cardiologist for long-term monitoring and management of heart disease.

What to Ask Your Doctor

  1. What are the benefits of off-pump coronary artery bypass surgery compared to on-pump surgery?
  2. What are the potential risks or complications associated with off-pump coronary artery bypass surgery?
  3. How experienced is the surgeon in performing off-pump coronary artery bypass surgery?
  4. Will a complete revascularization be possible with off-pump surgery, including the use of multiple arterial grafts?
  5. What are the long-term outcomes and success rates of off-pump coronary artery bypass surgery?
  6. Are there any specific factors or conditions that may make me a better candidate for off-pump surgery compared to on-pump surgery?
  7. How will my recovery process differ between off-pump and on-pump coronary artery bypass surgery?
  8. What is the cost difference between off-pump and on-pump surgery, and are there any potential additional costs associated with off-pump surgery?
  9. Are there any specific lifestyle changes or medications that I should consider post-surgery if I choose off-pump coronary artery bypass surgery?
  10. Are there any alternative treatment options that I should consider or be aware of before making a decision about off-pump coronary artery bypass surgery?

Reference

Authors: Lazar HL. Journal: Curr Opin Cardiol. 2015 Nov;30(6):629-35. doi: 10.1097/HCO.0000000000000221. PMID: 26352244