On Pump Open Heart Bypass Surgery byAss.Prof. Dr Hakan ERGUN.
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Coronary Artery Bypass Grafting (CABG): Surgical Procedures and Techniques
Coronary Artery Bypass Grafting (CABG) is a sophisticated surgical procedure designed to restore blood flow to the heart muscle by bypassing blocked arteries. The surgical process begins with the harvesting of healthy blood vessels, which will serve as the new grafts. The saphenous vein in the leg is frequently utilized due to its sufficient length for creating multiple grafts; however, if it is unsuitable, vessels from the arm may be used. Additionally, the left internal mammary artery is typically harvested for a single graft once the chest is opened.
Surgical Access and the Grafting Process
Following the recovery of the graft vessels, the surgeon performs an incision along the sternum (breastbone) to access the chest cavity. The sternum is carefully divided, providing the necessary exposure to the heart. During the procedure, the surgeon strategically places the grafts to either reroute blood flow around the obstruction or replace the blocked vessel entirely. The duration of the operation is primarily influenced by the number of grafts required and the surgeon's technical speed.
Traditional On-Pump CABG Procedure
In a traditional CABG procedure, the heart is temporarily stopped using a potassium solution. Bu technique ensures that the surgeon is not working on a moving vessel, providing a stable surgical field. During this stage, a heart-lung bypass machine takes over the functions of the heart and lungs, circulating oxygenated blood throughout the body while the ventilator is paused.
Pros and Cons of On-Pump Open Heart Surgery
| Avantajlar (Pros) | Dezavantajlar (Cons) |
|---|---|
| Quicker operation due to a still heart | Increased post-operative inflammation and clotting |
| Minimal blood in the field speeds up surgery | Higher likelihood of needing blood transfusions |
| Highly appropriate for unstable patients | Increased fluid retention and risk of kidney damage |
| Longer hospital stays and increased risk of stroke |
Off-Pump (Beating Heart) Surgery
Off-pump open heart surgery, also known as "beating heart" surgery, follows a similar protocol to the on-pump method but eliminates the need for a heart-lung machine. In this approach, the heart continues to circulate blood naturally. To facilitate the grafting, specialized surgical instruments are used to hold the specific area of the heart still while the rest of the organ continues to beat. Currently, approximately 20% of first-time CABG patients undergo this procedure.
Pros and Cons of Off-Pump Open Heart Surgery
Advantages (Pros):
- The heart remains moving (though this may slow the surgery).
- Reduced blood loss and fewer requirements for transfusions.
- Decreased risk of stroke and shorter hospital stays.
- Generally a less expensive surgical option.
Disadvantages (Cons):
- Up to 70% of patients are ineligible due to specific anatomy or medical conditions.
- This technique is rarely performed on unstable patients.
Post-Operative Closure
Once the grafting process is successfully completed, the heart is restarted to resume its role in providing blood and oxygen to the body. The sternum is returned to its original position and secured using surgical wire, which provides the necessary structural strength for the bone to heal. Finally, the external incision is closed to complete the surgery.
ASS. PROF. DR. Hakan ERGUN
