Off-Pump Coronary Artery Bypass Grafting

What Is Off-Pump Coronary Artery Bypass Grafting (CABG)?

Coronary artery bypass grafting (CABG) is a surgical procedure that restores blood flow to the heart muscle. This is done by using blood vessels from other parts of the body to make a new route, or bypass, for blood to flow around blocked coronary (heart) arteries.

In traditional CABG surgery, the patient’s heart needs to be stopped temporarily, so the patient is connected to a heart–lung machine that temporarily acts as the heart and lungs. Off-pump CABG, also called ‘beating heart’ surgery, can be done without stopping the heart and putting a patient on a heart–lung machine. Instead, a device is attached to the patient’s heart to stabilize it and the patient receives medicine to slow down the heart.

Reasons for the Procedure

Atherosclerosis is a disease of the arteries. Cholesterol and fatty deposits build up on the walls of the arteries. This restricts blood flow, causing decreased oxygen to the heart muscle. When the buildup happens in the heart, it may lead to angina (chest pain) or heart attack.

Lifestyle changes and medicines can be used to treat atherosclerosis. When the blockage gets too severe, CABG may be recommended to reestablish blood supply to the heart muscle.

Most people who require CABG surgery are candidates for the off-pump approach. Surgeons weigh several factors, such as the location of blocked arteries, a patient’s history of past thoracic surgeries, and the presence of coexisting diseases.

Off-pump CABG may be used to treat:

• Severe blockage in the main artery or in several blood vessels that supply blood to the heart
• Persistent angina that does not improve with other treatments

Description of Procedure

Before you are brought to the operating room (OR), you will have IVs placed and your skin prepped. Once in the OR, a breathing tube will be placed in your throat and you will be given general anesthesia until you are fully asleep.

An off-pump CABG surgery can either be done through a minimally invasive incision or a conventional approach.

An artery will likely be taken from your chest wall as well as a section of vein from the leg. These vessels will be used as the bypass grafts and will be connected to the blocked arteries.

During this procedure you won’t be on a heart–lung machine. Instead, a device will be attached to your heart to stabilize it and you will receive medicine to slow down the heart.

Possible Complications

If you are planning to have an off-pump CABG surgery, your doctor will review a list of possible complications, which may include:

• Bleeding
• Damage to other organs, such as the kidneys
• Infections
• Irregular heart rhythm
• Stroke
• Death

Some factors that may increase the risk of complications with heart surgery include:

• Diabetes
• Kidney disease
• Lung disease, especially chronic obstructive pulmonary disease (COPD) (emphysema)
• Obesity
• Prior heart attack or cardiac surgery
• Smoking

What to Expect

Prior to Procedure

Your doctor will likely do the following:

• Physical exam
• Chest X-ray
• Lab work
• Echocardiogram
• Electrocardiogram (ECG, EKG)
• Cardiac catheterization

Talk to your doctor about your medication. You may need to stop taking certain medication for one week before surgery, such as:

• Blood-thinning drugs, such as warfarin (Coumadin)
• Anti-platelet drugs, such as clopidogrel (Plavix)
• Diabetes medications, such as metformin (Glucophage)

Your doctor may also ask you to:

• Eat a light meal the night before. Do not eat or drink anything after midnight.
• Arrange for a ride to and from the hospital
• Arrange for help at home after the procedure

Anesthesia

General anesthesia will be given. You will be asleep during the procedure.

Immediately Afterwards

You will be monitored in the Intensive Care Unit (ICU), where you will have the following interventions:

• Heart monitor
• Pacing wires to control heart rate
• Tubes connected to a machine to drain fluids from the wound
• Breathing tube or an oxygen mask
• Catheter inserted into the bladder

Post-Procedure Care

At the Hospital

• To reduce the risk of fluid buildup in your lungs, you will be instructed to breathe deeply and cough 10 to 20 times every hour.
• If a leg vein was removed, elevate your legs above your heart while sitting. Do not cross your legs.
• Efforts will be made to get you out of bed and walking as soon as possible.
• Dressings will be removed in a day or two. Pacing wires and chest tubes will be removed within the first few days.

Back at Home

When you return home, do the following to help ensure a smooth recovery:

• Take medicines as directed by your doctor, such as:
  
  • Antiarrhythmics
  • Blood thinners
  • Cholesterol-lowering medicine
  • Blood pressure medicine
  • Pain medicine
• Follow your doctor’s guidelines for caring for your stitches
• Weigh yourself every morning
• Be sure to follow all of your doctor’s instructions

Recovering after Surgery: What to Expect

Every patient’s recovery can be different. You will need to shower, daily, with a mild soap. Ask your doctor when it is safe to take a bath or soak in water. You may find that there will be some areas of discomfort in the area of surgery that can last for several weeks. Also, it is common that you may feel tired for many weeks following this type of surgery.

If your surgery followed the conventional approach (versus the minimally invasive approach), you will be asked not to do any type of heavy lifting for two months that will cause pain at the surgical site. People with jobs requiring strong physical activity may require additional time before resuming those types of activities. Be sure to ask your doctor when you can drive and return to work.

When to Call Your Surgeon

Check in with us as soon as possible if you experience any of these serious symptoms:

• Pain that you cannot control with the medication you have been given
• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision sites
• Nausea and/or vomiting that you cannot control with the medication you were given after surgery or that lasts longer than expected
• Cough, shortness of breath, or chest pain
• Pain, burning, urgency, frequency of urination, or persistent blood in the urine
• Gaining more than four pounds within one or two days
• Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain

In case of an emergency, call for medical help right away.

Frequently Asked Questions

How long will it take?

The surgery can take anywhere from 3 to 6 hours.

How much will it hurt?

Anesthesia prevents pain during surgery. You may be given medication for any pain during recovery. Pain levels vary from patient to patient.

What is the average hospital stay?

The average stay is 3 to 6 days.

Meet with a Doctor within One Week

To learn more about how we can help you, contact us. We’ll return your call the same day and can secure you an appointment with one of our doctors within the week.

Call 617.789.2045 to request an appointment.

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