Beating heart,off pump coronary artery by pass graft (opcab) progresing toward less invasive coronary surgery ,eleminates or atleast minimizes mortality and morbidity associated with the use of cardiopulmonary by pass .
Recent progress in mechanical stabilizers has greatly contrbuted to facilitating ,increasing the efficacy of beating heart surgery .
Minimal invasive direct coronary artery bypass surgery (mid cab).Although avoids cardiopulmonary bypass(cpb)
is only applicable to very small segment of the population with coronary heart disease (5%-10%) that is limited to cases that require one or two anterior heart vessel revascularization ,consequently incisions have been progressively lengthened to gain exposure to all coronary arteries including the posterior vessels .
Incresing interest in minimally invasive offpump cabg surgery and frequency of reported clinical results has initiated the medical debate to consider whether this approach is selective or more universaly adopted ,as alternative to conventional cabg for complete revscularization of the coronary heart disease .
To this end a valid alternative to conventional cabg must routinly be used and be suitable in treating all coronary arteries,accomplish equivalent quality grafts,not compromise morbidity and mortality and sustain a low acceptable rate of conversion to CPB.
Successful clinical introduction of of cpb by J Gibbon in 1953 has facilitated variety of complex cardiac surgical procedures . Use of cpb until recently has been synonymous with CABG surgery .World wide estimated 800,000 cabg performance annually.
Steadily accumulative evidence of some degree of end -organ dysfunction associated with its use are being reported .Some studies documented 6% incidence of serious adverse neurological events ,in surgery of 2108 patients under going cabg at 24 us institutions 3% perioperative strok while 3% prolong unconsciousness , seizures or encephalopathy . Patients with neurological deficit had significant prolong hospitalization, and 47% transfered to chronic care facilities .
Subtle neurological and cognetive deficit can be detected through neuropsychological analysis,and some have
reported in up to 50% of patients post CPB.
Blood conact with tubing and surface of cpb circuit produce systemic inflmmatory reaction that effect multi organ system. Specific adverse effects on Heart Lungs Central nervous system Kidneys,and gastrointestinal tract are cause for major morbidity ,mortality in post operative patients.
Beating heart(opcab),off pump surgery results in less potential for brain emboli and appear to produce a lower incidence of cognetive dysfuncion in post operative follow up, in comparrison with conventional coronary artery bypass surgery using cpb.
Ten years ago Benetti, Buffalo of south America pioneered the opcab and demonstrated that it is possible to perform cabg while the heart is beating. Further contributions of Calafiore (Italy), Lima (south America) and U.S surgeons also introduced more effective stablizing devices. This has made the procedure more utilized by a majority of U.S surgeons,with lower mortality and morbidity, even in sicker group of patients.
