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Cardiac Surgery

Beating Heart Bypass

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Recent medical advances allow patients with diabetes, poor physical health, or a history of stroke to undergo beating heart bypass surgery, which gives them a decreased risk for developing complications related to the heart-lung machine used in traditional coronary artery bypass surgery.

The coronary arteries deliver blood to the heart muscle. Coronary artery disease keeps the heart from getting enough blood, because one or more of the arteries are narrowed or blocked by an accumulation of plaque. When an artery is blocked, bypass surgery creates a new route for blood to flow through, bypassing the blocked part of the artery. In most cases, the surgeon uses a healthy blood vessel from the chest or leg to create this pathway. The healthy artery or vein, called a graft, is attached to the blocked coronary artery, providing an alternate route for the blood to travel through.

Traditional coronary artery bypass surgery uses the heart-lung machine to temporarily take over the heart's function of supplying the blood with oxygen and pumping it back through the body. This allows the surgeon to stop the heart in order to perform the bypass without interference from the motion of the beating heart.

Beating heart bypass surgery, on the other hand, is performed while the heart is still beating. This procedure generally means a quicker recovery time as well as a lower risk for stroke and other neurological effects. In most cases, the elimination of the heart-lung machine means less surgical trauma for the patient. In some cases, a patient undergoing beating heart bypass surgery may need the heart-lung machine, although it will not be used to stop the heart.

 

The Surgery

Access to the Heart
The surgeon makes an incision down the middle of the chest and separates the breastbone, or sternum, to get to the heart. After surgery, the breastbone is rejoined with wires or heavy suture and the incision is sewn up. In many cases, the breastbone heals in 6-8 weeks.

Obtaining and Attaching the Graft
A separate surgical procedure performed during bypass surgery removes the healthy vessel from the chest, arm, or leg. The vessels most often used as grafts are the internal mammary arteries along the inside of the chest wall, the radial arteries in the arms, and the saphenous veins in the legs. Blood flow in the body is generally not affected by removing these vessels. An alternative to traditional vessel removal surgery is called Endoscopic Vessel Harvesting.

Once the graft is available, one end of the vessel is sewn to an opening in the coronary artery below the blockage. If a radial artery or a saphenous vein is used, the other end is sewn onto the aorta. If a mammary artery is used, the other end is already attached to a branch of the aorta. The entire bypass procedure usually takes 4-6 hours.

You're in Good Hands
You can feel confident knowing a skilled heart surgery team is performing your bypass surgery. The team includes the heart surgeon and surgical assistants; several specially trained nurses; an anesthesiologist, who constantly monitors your anesthesia to help you sleep without pain; and a perfusionist, who operates the heart-lung machine in cases where it is necessary. With the help of highly advanced technology, these specialists will ensure the safest possible surgery for you. For information on Montana Heart's exemplary surgery outcomes, visit our Outcomes page.

For important information on risks of and preparation for the surgery, see Before Cardiac Surgery.

For post-operative information, see After Cardiac Surgery.

 

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