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Cardiovascular surgery advances
In September 2004, former President Bill Clinton successfully had a quadruple bypass. His surgery is one of the 300,000 coronary bypass operations that will be performed in the United States this year. Clinton’s surgery was “on-pump,” meaning his heart was stopped and he was put on a heart-lung machine. Increasingly, bypass patients are requesting a newer procedure that eliminates the use of the machine. However, this may not be the best procedure for everyone.

For years, coronary bypass surgeries have been successfully performed “on-pump” using a heart-lung machine, which allows the heart to be temporarily stopped during the procedure. In the last decade, however, more surgeons are opting to perform “off-pump” surgeries (also called beating heart bypass) without the heart-lung machine.

New precision instruments allow the surgeon to stabilize a small area of the heart and place a bypass graft, while the rest of the heart continues to beat normally.

Palmetto Health Heart Hospital cardiovascular surgeon Dr. Reid Tribble says there are some benefits to beating heart or “off-pump” surgery. “Off-pump surgery is an advancement in coronary artery bypass that is useful for some patients, but the heart-lung machine is still an excellent tool. Surgeons choose the best procedure by taking into account the individual needs and condition of each patient.”

Dr. Tribble says the decision to go on- or off-pump for bypass surgery depends greatly on the patient’s condition and the location of diseased blood vessels. Patients who are healthy, aside from needing bypass surgery, are better candidates for on-pump surgery.

Off-pump surgery is more beneficial for high-risk patients who may have existing kidney or lung problems or hardening of the aorta. “Often off-pump surgery is chosen for patients who have only one diseased blood vessel. If there are multiple vessels that need work, on-pump surgery usually makes the most sense,” explains Dr. Tribble. “And recently, concerns have been raised about the bypass graft being open at one or two years post off-pump surgery.”

“There are benefits to both types of surgeries, but it is important to remember that patients whose health is generally good will have good results on- or off-pump. The best approach depends on the individual patient,” says Dr Tribble.

On-pump surgery utilizes the heart-lung machine, which allows for cardiopulmonary bypass (CPB). The patient’s blood flow is rerouted through the machine and then the heart is stopped. After work on the heart is finished, blood flow is restored, allowing the heart to function normally.

Off-pump or beating heart coronary bypass surgery is done through the same incision as on-pump surgery. With modern stabilizing techniques, the heart continues to beat while the surgeon sews on the bypass graft.