Our Summary

This study looks at a type of heart surgery called off-pump coronary artery bypass (OPCAB), which is an alternative to the more traditional coronary artery bypass grafting that uses a heart-lung machine. However, sometimes during OPCAB, doctors need to switch to using the heart-lung machine due to complications - this is called ‘conversion’. There’s been concern that this conversion carries a significant risk of death.

So, the researchers analyzed data from over 3000 OPCAB surgeries performed in India between 2013 and 2016. Out of these, about 3% needed to be converted to traditional surgery. They found that the death rate in this group was much higher (5.56%) compared to those who didn’t need conversion (0.06%).

The researchers also found that certain factors increased the likelihood of needing conversion and the associated risk of death. These included being female, having a higher pressure in the heart’s left ventricle, and needing a device called an intra-aortic balloon before surgery. Patients who had to be converted also had longer hospital stays and needed more time on a ventilator.

In conclusion, while OPCAB is a preferred technique for heart surgery, conversion to traditional surgery when complications arise can lead to a significantly increased risk of death. This study helps identify certain factors that can predict this risk.

FAQs

  1. What is off-pump coronary artery bypass (OPCAB) surgery?
  2. What factors increase the likelihood of needing conversion from OPCAB to traditional surgery?
  3. What are the risks associated with the conversion from OPCAB to traditional heart surgery?

Doctor’s Tip

Therefore, it is important for patients undergoing OPCAB to discuss with their doctor about the possibility of conversion and the associated risks. It’s important to be aware of these factors and to closely monitor for any signs of complications during and after surgery. By being informed and proactive, patients can work with their healthcare team to ensure the best possible outcome for their heart bypass surgery.

Suitable For

Patients who are typically recommended heart bypass surgery, including OPCAB, are those with severe coronary artery disease that cannot be managed effectively with medications or less invasive procedures. These patients may have symptoms such as chest pain (angina), shortness of breath, and fatigue, as well as evidence of significant blockages in their coronary arteries on diagnostic tests like angiography.

Specific factors that may increase the likelihood of needing heart bypass surgery include:

  • Severe blockages in multiple coronary arteries
  • Left main coronary artery disease
  • Previous heart attacks or other cardiac events
  • Diabetes
  • Poor heart function
  • Inability to undergo other treatments such as angioplasty or stenting

Ultimately, the decision to recommend heart bypass surgery is made on a case-by-case basis by a team of cardiac specialists, taking into account the patient’s overall health, the severity of their coronary artery disease, and their individual risk factors for complications during and after surgery.

Timeline

Timeline of patient experiences before and after heart bypass surgery:

Before surgery:

  1. Patient undergoes pre-operative tests and evaluations to assess their overall health and determine the need for surgery.
  2. Patient meets with their cardiac surgeon to discuss the procedure, risks, and potential outcomes.
  3. Patient may need to make lifestyle changes, such as quitting smoking or improving diet, to optimize their health before surgery.

During surgery:

  1. Patient is taken into the operating room and prepared for surgery.
  2. Surgeon performs the bypass surgery, either using the traditional method with a heart-lung machine or the off-pump method without a heart-lung machine.
  3. If complications arise during surgery, the patient may need to be converted to traditional surgery with the heart-lung machine.

After surgery:

  1. Patient is transferred to the intensive care unit for monitoring and recovery.
  2. Patient may need to remain on a ventilator for a period of time to assist with breathing.
  3. Patient is gradually weaned off medications and monitored for any complications.
  4. Patient begins physical therapy and rehabilitation to regain strength and function.
  5. Patient is discharged from the hospital and continues follow-up appointments with their cardiac surgeon and cardiologist.
  6. Patient makes lifestyle changes and takes medications as prescribed to maintain heart health and prevent future complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about heart bypass surgery, specifically OPCAB, include:

  1. What is the likelihood of needing to convert to traditional surgery during an OPCAB procedure?
  2. What factors increase the risk of needing conversion during OPCAB?
  3. What are the risks associated with conversion to traditional surgery during OPCAB?
  4. How will you monitor and manage any potential complications during the surgery?
  5. How will my recovery and outcome be affected if conversion is needed during my surgery?
  6. Are there any alternative treatment options available if complications arise during the surgery?
  7. How many OPCAB procedures have you performed, and what is your experience with managing complications during surgery?
  8. What can I do to reduce my risk of needing conversion during OPCAB surgery?
  9. What is the typical recovery process after OPCAB surgery, and how does conversion to traditional surgery impact this process?
  10. What are the potential long-term effects or complications associated with undergoing OPCAB surgery, including the risk of conversion to traditional surgery?

Reference

Authors: Chakravarthy M, Prabhakumar D, Patil TA, George A, Jawali V. Journal: Ann Card Anaesth. 2019 Jan-Mar;22(1):18-23. doi: 10.4103/aca.ACA_227_17. PMID: 30648674