Coronary artery bypass surgery is traditionally performed with cardiopulmonary bypass. The heart-lung machine allows the heart to be stopped, so that the surgeon can operate on a surface which is blood-free and still. The heart-lung machine maintains life despite the lack of a heartbeat, removing carbon dioxide from the blood and replacing it with oxygen before pumping it around the body.
A desire to improve outcomes after surgery have led surgeons to perform coronary artery bypass surgery without cardiopulmonary bypass in a procedure called off-pump bypass surgery.
Off-pump coronary artery bypass surgery differs from traditional coronary artery bypass surgery because the heart-lung machine is not used. Rather than stopping the heart, the surgeon stabilizes portions of the heart during surgery. With a particular area of the heart stabilized, the surgeon can go ahead and bypass the blocked artery in a highly controlled operative environment. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body.
Off-pump coronary artery bypass surgery may be performed in certain patients with coronary artery disease. With present technology, all arteries on the heart can be bypassed off-pump. It may be ideal for certain patients who are at increased risk for complications from cardiopulmonary bypass, such as those who have heavy aortic calcification, liver cirrhosis, or compromised pulmonary or renal function. Not all patients are a candidate. The selection of patients who undergo off-pump surgery is made at the time of surgery when the patient’s heart and arteries are evaluated more closely.