In 1995, an innovative technique in heart coronary bypass surgery, known as off-pump beating heart coronary surgery (OPCAB), was pioneered at the Bristol Heart Institute, part of the University of Bristol.
The technique significantly reduces the risk of post-operative morbidity, time in intensive care and length of hospital stay, and is becoming increasingly popular worldwide. OPCAB is now used in 15-20% of all coronary artery bypass grafting surgery, with the Bristol Heart Institute performing over 750 such operations a year.
Conventional ‘on pump’ surgery
During surgery, the heart is normally paralysed by a cardioplegic solution, while blood is diverted from the vascular system and pumped through plastic tubing outside the body. This artificial pump temporarily performs the functions of the heart and lungs.
Today, the risks of on pump heart surgery are greater than they were 20 years ago. This is because many people face heart surgery later, and, as a consequence, have more serious heart disease and require urgent or emergency procedures more frequently.
New solutions that improve lives and reduce costs
The new technique - beating heart surgery - uses a special stabiliser to keep a small part of the heart still, so the surgeon can operate on that part while the rest of the heart keeps beating. The technique is known as ‘off-pump’ surgery, since there is no need for the artificial pump.
Beating heart surgery results in fewer post-surgery complications, such as infections due to inadequate clearance of fluid from the lungs and temporary kidney failure. There is also less blood loss and transfusion requirement, and reduced damage to the heart muscle itself. The technique generates a 25% cost saving per patient, and has proved particularly beneficial for obese patients, reducing inhospital mortality and neurological injury.
Continued monitoring of early and long-term outcomes for patients, including in-hospital outcomes, survival rates and quality of life, and the provision of training for cardiac surgeons in off-pump techniques are now under way to determine whether off-pump surgery performed on the beating heart will supersede conventional surgery.