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Off-Pump Bypass Surgery

Off-pump bypass surgery differs from traditional bypass surgery in that the heart remains beating throughout the procedure and a heart-lung machine is not generally used. The surgery involves administering anesthesia, opening the chest, attaching the graft, and possibly placing pacing wires on the heart to normalize the heartbeat. Off-pump bypass surgery is concluded by closing the breastbone and placing drainage tubes in the chest.

Off-Pump Bypass Surgery: An Introduction

Bypass surgery is a procedure that takes a blood vessel from somewhere else in the body and uses it to bypass a vessel in the heart that has become damaged and blocked. This improves the blood supply to the heart and, in turn, improves the delivery of oxygen and nutrients to the heart muscle. There are a couple of ways to perform heart bypass surgery. One way is the traditional method (see Bypass Surgery). The other method is called off-pump bypass surgery or beating heart bypass surgery. As the name implies, beating heart bypass surgery is performed while the heart is still beating, and off-pump bypass surgery refers to the fact that the heart-lung machine is not used.

What Happens During Off-Pump Bypass Surgery?

After your anesthesia takes effect (see Anesthesia for Bypass Surgery), the surgical area will be scrubbed with a special disinfectant soap and may also be shaved.
Your surgeon will then make a 6- to 8-inch incision down the middle of your chest. Your breastbone is then separated, the heart sac is carefully pulled back, and your heart is examined.
At this point, your surgeon will take out the graft vessel that will be used to make a new path around the blockage. This graft may come from the mammary artery, which is inside your chest, the radial artery, which is in your forearm, or from a vein in the leg. The choice of which blood vessels are used as grafts will depend on your particular situation.
Your surgeon will then carefully move your heart so that the blocked area is easy to reach and put the heart stabilizer near the blocked blood vessel. While the movement of the heart in this area is reduced, the graft will be sewn into place. One end of the graft is attached to a healthy blood vessel, and the other end is sewn on below the blocked section of your coronary artery. Blood can now flow around the blockage, so more of it gets to your heart. If you have more than one blocked artery, your doctor will repeat these steps for the other blockages.
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