Surgery begins with harvesting the blood vessels that will become the grafts. The saphenous vein in the leg is commonly used because it is long enough to create multiple grafts. If the saphenous vein cannot be used, vessels from the arm can be used instead. The left internal mammary artery is used for a single graft and is taken once the chest is opened for surgery.
Once the saphenous vein has been recovered, the chest is opened by making an incision along the sternum, or breastbone. The surgeon then cuts the sternum, allowing the chest cavity to be opened, giving the surgeon access to the heart.
In the traditional CABG procedure, the heart is stopped with a potassium solution so the surgeon is not attempting to work on a moving vessel, and the blood is circulated by a heart-lung machine. At this time the heart-lung machine does the work of the heart and the lungs, and the ventilator is not used.
The surgeon places the grafts, either rerouting blood around the blockage, or removing and replacing the blocked vessel. The amount of time on the heart-lung bypass machine is determined by the speed at which the surgeon is able to work, primarily, how many grafts are needed.
Once the grafts are complete, the heart is started and provides blood and oxygen to the body. The sternum is returned to its original position and closed using surgical wire, to provide strength the bone needs to heal, and the incision is closed.
Pros of On Pump Open Heart Surgery:
Surgeon can operate quicker because the heart is still Very little blood makes surgery faster Appropriate for unstable patients
Cons of On Pump Open Heart Surgery:
Increased inflammation/clotting after surgery
Transfusion more likely after surgery than with off pump
More fluid retention than off pump
Higher risk of kidney damage than off pump
Longer hospital stay than off pump
Increased risk of stroke
Off Pump Open Heart Surgery:
The procedure for beating heart, or “off-pump” surgery is essentially the same as the on pump surgery, but the flow of blood through the body is maintained by the heart during the procedure. Instead of using a heart-lung machine, the heart continues to beat but the area being grafted is held still by surgical instruments. Approximately 20% of first time CABG patients have off pump surgery.
Pros of Off Pump Open Heart Surgery:
The heart is moving, slowing surgery
Less blood loss and fewer transfusions
Decreased risk of stroke
Decreased length of hospital stay
Less expensive
Cons of Off Pump Open Heart Surgery:
Up to 70% of patients ineligible due to anatomy or medical condition
Rarely performed on an unstable patient
ASS.PROF.DR.Hakan ERGUN
