Is OPCAB (Off-Pump Coronary Artery Bypass) Worth The Pain And Effort?

OPCAB - Off-Pump Coronary Artery Bypass

Isn’t it interesting to know that the first ever successful bypass was done as a beating heart operation? This was way back in 1964 by a Russian surgeon, Colosev. But since then the conventional bypass operation has developed as a safe procedure and has stood the test of time.

Interest in OPCAB (Off-Pump Coronary Artery Bypass) was rekindled in the late 80s and 90s. Due to the steep learning curve and lack of evidence for better outcome compared to standard operation, many surgeons lost initial enthusiasm and went back to the old time tested methods. The few who persisted – many of them in India- have provided valuable information regarding the safety and efficacy of this demanding surgery.

From the emerging data across the world it is now clear that OPCAB can be as complete a bypass operation as the standard one. It provides better results in terms of early deaths, strokes and kidney failures. The difference becomes far more apparent in high risk patients especially very old and those having diminished kidney or lung functions. One of the most important areas where OPCAB is making its mark is the field of repeat operations. OPCAB reduces the blood loss and recovery time in those situations.

In short, OPCAB in experienced hands is as complete and more safe than the standard operation. It may be ideally suited in very old and critically sick patients.

How is OPCAB done?

It is clear that OPCAB would be technically more difficult to perform than conventional bypass for the plain fact that the fine surgical work needs to be done while the surface is still moving. There are certain devices which make the process a bit easier for the surgeon. Most important of them is called a tissue stabilizer.

Tissue Stabilizer

This, when applied over the heart stabilizes a small portion of the heart wall and reduces the movement in that region. This makes surgical procedure a lot easier to perform. There are other devices which add to the safety like shunts which prevent blood loss and blowers which help to clear operating field.

Can All Patients Needing Bypass Have OPCAB?

This is a very technical question and one need to consider many factors before reaching a decision.

Even when OPCAB (Off-Pump Coronary Artery Bypass) is planned for a certain patient the decision can be changed on the operating table depending on conditions unique to individual patients.

A heart suffering from critical shortage of blood supply, as in the case of many undergoing bypass, may not tolerate the long operation on beating heart.

The blood vessel needing bypass may be buried deep inside the heart muscle or its wall may be very thick and hard like stone.

These situations make the operation technically difficult and may necessitate the use of CPB machine. Needless to say, every patient is unique and there is no one treatment suiting all.