What happens during off-pump coronary artery bypass graft surgery (CABG)?

In many cases, coronary artery bypass grafting can be performed without the use of the heart-lung machine. In this "off-pump" (also called beating heart) technique, a small vertical incision is made in the chest and a mechanical stabilizing device is used to restrict movement of the heart so that the surgeon can perform surgery while the heart is beating. Patients may be given a drug to slow the heart rate, but the heart maintains its own rhythm without the assistance of the heart-lung machine. The potential benefits of off-pump surgery include a shorter hospital stay and recovery time, less bleeding, less potential for infection and less trauma.

Off pump means without the use of a heart-lung bypass machine. Open heart surgeries performed on beating (not stopped) hearts are called "off-pump" surgeries—they don't require the use of a heart-lung bypass machine.

During CABG the person typically will be connected to a heart-lung machine (sometimes called “the pump”), which is a machine that temporarily takes over the function of the heart and lungs during surgery to maintain blood circulation and oxygen flow through the body. The heart-lung machine allows the surgeon to stop the heart in order to carefully and accurately sew the bypass grafts to the heart. After the surgery is completed, the person will be taken off the pump, and the heart and lungs will resume their function.

Some surgeons prefer to perform CABG surgery without the use of the heart lung machine (“off pump”) by sewing the coronary bypass grafts to the coronary arteries with the heart beating. This technique requires the use of instruments that stabilize or hold the area of the coronary artery being bypassed still so that the surgeon can carefully and accurately sew the graft to it.

Off-pump or beating heart CABG was developed in an attempt to decrease the chances of complications after surgery, including bleeding, stroke, lung problems and kidney toxicity. It may also be more economical to perform because it eliminates the costs of the heart lung machine. Off-pump CABG has been proven to be safe and effective in the hands of many surgeons.

This content originally appeared online in "The Patient Guide to Heart, Lung, and Esophageal Surgery" from the Society of Thoracic Surgery.

Off-pump coronary artery bypass grafting stabilizes the surface of the heart during the procedure. In this video, I will discuss the benefits of off-pump grafting.

Your heart contains coronary arteries that can become diseased when cholesterol builds up to form plaque in the lining of the artery.

Coronary artery bypass graft surgery (CABG) creates new pathways around the areas of your blocked arteries, allowing blood flow to be restored. Your blocked coronary arteries are bypassed with an artery or vein taken from another part of your body (leg, chest or arm).

During off-pump coronary artery bypass graft surgery (CABG):

  1. Once the chest has been opened, the area around the artery to be bypassed will be stabilized with a special type of instrument.
  2. The rest of the heart will continue to function and pump blood through the body.
  3. The cardiopulmonary bypass machine and the perfusionist who runs it may be kept on stand-by should the procedure need to be completed on bypass.
  4. The physician will perform the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the coronary artery just above the blockage, and the other end over a tiny opening made in the coronary artery just below the blockage.
  5. You may have more than one bypass graft performed, depending on how many blockages you have and where they are located.
  6. Before the chest is closed, the physician will examine the grafts to make sure they are working.
Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

When surgery is performed “off-pump,” it means the heart is not stopped and a heart-lung machine does not take over the functions of the heart and lungs during the procedure. Learn more about this procedure by watching this animation.

Dr. Ramon M. Anastacio, MD
Cardiologist (Heart Specialist)

Off-pump coronary artery bypass (OPCAB) is a beating heart surgery that allows the surgeon to sew the bypass grafts into place without stopping the heart. The chest is opened as in conventional open-heart surgery.

In off-pump cardiac artery bypass surgery (OPCAB), a doctor repairs the heart without having to stop it. In this video, cardiothoracic surgeon Craig Smith explains why 25 percent of heart surgeries are now done this way.

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