In spite of great advancements in techniques of cafdio pulmonary bypass, it is still not physiological. There can be various complicatioils related to perfusion.Off pump surgery is based on the principle that if a safe operation can be done
on a beating heart without sacrificing the quality o l surgery, it will be beneficial to the patient.
Application
Off Puirzp Coronary Artery Bypass Surgery (OPCAB)
CABG is done on epicai-dial vessels. Cardio pul~nonary by pass is used only to get a stilI heait for accurate anastomosis. If there is a method of stabilizing a small area of the hearl over the coronary artery with the rest or heart beating and mnintaining reasonable haemodynamics, it is possible to do the operation off pump (OPCAB) or beating heart surgery. A few ingenious mechanical stabilizers
achieve the local stabilization. The mosl cornillonly used one currently is "OCTOPUS", which has two blades with suckers. The two blades are placed on either side of the target artery and mild suction applied on lhc suckers. Another equipment "STARFISH" which resembles its namcsakc in the ocean, when applied to the apex of the heart helps in exposing any surface of the heart as required without much haemodynamic compromise.
When a partially occluded coronary or a 100 per cent blocked artery with good collaterals is opened, there will be considerable bleeding. To control that,suitably sized i~itra luminal shunt devices are available. They help to control bleeding, permit distal perfusion and do not interfere with the anasto~iiosis.While the last few sutures are being applied, the shunt is re~iloved arid anastomosis is conlpleted. When a shunt is not used, a carbon dioxide blower will help in keeping the field free of blood.
To perforin successful OPCAB good cooperation between the surgeon and tlie anesthesiologist is needed. Controlled hand ventilatioli is needed at crucial stages. Arterial pressure and ECC changes like ST-T changes are monitored when heart is rotated or translocated into light pleura. Trans oesophagenl ECHO helps in rnonitorillg region wall motion of left ventricle. Usually. the operation is done through median stenlotomy. Minimally invasive techniques or a left thoracotomy may be used in selectcd cases. Before grafting, hepasin is administered in doses of 1-3 ingfkg. Hypothernlin is LO be avoided.
A pump is kept standby which could be assembled, primed and go1 ready in a matter of few minutes. It is imporlalit to make the anastomosis accurate. The advantage of OPCAB is that recovery is faster Patient can be extuhated same day, transferred fmnl ICU next day and discharged in 6-7 days ti~nc. This brings down the cost of hospitalization significantly.
on a beating heart without sacrificing the quality o l surgery, it will be beneficial to the patient.
Application
Off Puirzp Coronary Artery Bypass Surgery (OPCAB)
CABG is done on epicai-dial vessels. Cardio pul~nonary by pass is used only to get a stilI heait for accurate anastomosis. If there is a method of stabilizing a small area of the hearl over the coronary artery with the rest or heart beating and mnintaining reasonable haemodynamics, it is possible to do the operation off pump (OPCAB) or beating heart surgery. A few ingenious mechanical stabilizers
achieve the local stabilization. The mosl cornillonly used one currently is "OCTOPUS", which has two blades with suckers. The two blades are placed on either side of the target artery and mild suction applied on lhc suckers. Another equipment "STARFISH" which resembles its namcsakc in the ocean, when applied to the apex of the heart helps in exposing any surface of the heart as required without much haemodynamic compromise.
When a partially occluded coronary or a 100 per cent blocked artery with good collaterals is opened, there will be considerable bleeding. To control that,suitably sized i~itra luminal shunt devices are available. They help to control bleeding, permit distal perfusion and do not interfere with the anasto~iiosis.While the last few sutures are being applied, the shunt is re~iloved arid anastomosis is conlpleted. When a shunt is not used, a carbon dioxide blower will help in keeping the field free of blood.
To perforin successful OPCAB good cooperation between the surgeon and tlie anesthesiologist is needed. Controlled hand ventilatioli is needed at crucial stages. Arterial pressure and ECC changes like ST-T changes are monitored when heart is rotated or translocated into light pleura. Trans oesophagenl ECHO helps in rnonitorillg region wall motion of left ventricle. Usually. the operation is done through median stenlotomy. Minimally invasive techniques or a left thoracotomy may be used in selectcd cases. Before grafting, hepasin is administered in doses of 1-3 ingfkg. Hypothernlin is LO be avoided.
A pump is kept standby which could be assembled, primed and go1 ready in a matter of few minutes. It is imporlalit to make the anastomosis accurate. The advantage of OPCAB is that recovery is faster Patient can be extuhated same day, transferred fmnl ICU next day and discharged in 6-7 days ti~nc. This brings down the cost of hospitalization significantly.
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