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Posted on in Heart Health

Heart Bypass Surgery… While the Heart is Beating

Medically Reviewed by Scott Schultz, MD

Over 300,000 patients with coronary artery disease undergo heart bypass surgery each year. Hear the words “heart bypass surgery,” you might think of the traditional approach which includes stopping the patient’s heart for about an hour.  During this time, blood is diverted into a heart-lung machine that keeps the patient alive, while the surgeon sews arteries or veins from the leg or arm beyond the blocked arteries on the heart.

Alternatively, surgeons can use a technique that keeps the heart beating during bypass surgery.

“I believe, for most patients, it is the best operation,” says McLeod Cardiothoracic Surgeon Dr. Scot Schultz, who has performed more than 1,500 beating heart bypasses.  “It is technically challenging – like changing the oil in your car while the engine is running – but there are a number of advantages for the patient.”

The advantages over so-called “on-pump” bypass surgery include:

  • Less time in the hospital. Most people have 4-6 day hospital stays. 
  • But some patients can be discharged as early as the third day after surgery. 
  • Faster recovery, including a shorter stay in intensive care. 
  • Fewer complications, including irregular heart rhythm (arrhythmias), strokes, lung and neurological disorders (strokes).

The off-pump bypass has been shown in more than one study to benefit specific types of patients

1) Jehovah’s witnesses, whose religious beliefs do not allow blood transfusions, 

2) Elderly patients, 

3) Female patients and 

4) Patients who are at risk due to poor lung function such as COPD.

Beating heart surgery is not for all patients. For instance, someone who has had a previous heart surgery often times has scar tissue making manipulation of the heart more difficult.

Interestingly, the beating heart (or off-pump) bypass surgery was being performed as early as 1969.  But, with the development of the heart-lung bypass machine, beating heart surgery dwindled until near the turn of the 21st century. Improvements in surgical and anesthetic techniques helped spark the resurgence of beating heart bypass surgery.

Currently, only about 10% of the country’s heart surgeons perform the beating heart bypass, which may not be surprising if you consider it requires the ability to sew on a moving target less than two millimeters in size—less than the thickness of two dimes. To stabilize the heart, Dr. Schultz uses a device with soft silicone suction cups that steady the small area of the heart, where he needs to operate.

Final Thought.  

If you’re experiencing blockages around the heart and are told that you need bypass surgery, ask your surgeon if you would be a candidate for the beating heart procedure.

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Sources include: McLeod Health, Emedtv.com, Critical Care Nursing, International Journal of Cardiology, American Heart Journal, University of South Hampton, National Institutes of Health, Society of Thoracic Surgery

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