Coronary artery bypass without a heart-lung machine

The coronary artery bypass surgery without cardiopulmonary bypass (ger .: off-pump Coronary Artery Bypass , OPCAB ) is a new, as yet generally established procedure for the surgical treatment of coronary heart disease .

Procedure

In contrast to the classic coronary artery bypass operation , the beating heart is operated on without a heart-lung machine (HLM). The heart is fixed in the area of the bypass connection ( anastomosis ) and in the area of the apex in the longitudinal axis by a stabilizer. The side walls and the back wall of the heart are also accessible. During the entire operation , the blood flow in the coronary arteries is ensured through small tubes that are inserted into the coronary arteries to be supplied.

advantages

By installing the heart-lung machine in the ascending aorta (main artery), there is a risk of calcification loosening from the vascular wall, which can then trigger a stroke . This risk is reduced.

HLM causes a non-specific inflammatory reaction in the body through contact with foreign surfaces . Under unfavorable conditions, this reaction can lead to a deterioration in organ functions (lungs, liver, kidneys), but this is generally reversible and of minor importance.

disadvantage

The procedure is technically more demanding for the surgeon. It is therefore more likely to be used when not all three coronary arteries have to be supplied with bypasses. In comparable patients, the results in terms of death, heart attack and re-operation are comparable to the conventional method.

swell

MediClin Heart Center Lahr / Baden: Bypass surgery on the beating heart without a heart-lung machine (OPCAB) . 2009. Retrieved March 28, 2009.

Individual evidence

↑ German Medical Association , National Association of Statutory Health Insurance Physicians , Association of the Scientific Medical Societies in Germany (eds.): National Disease Management Guideline Chronic CHD - Long version (PDF, 1.5 MB) 2008. Accessed March 28, 2009. ( Page no longer available , searching web archives ) Info : The link was automatically marked as broken. Please check the link according to the instructions and then remove this notice.@1@ 2Template: Dead Link / www.bdc.de
↑ JM Douglas, SE Spaniol: A multimodal approach to the prevention of postoperative stroke in patients undergoing coronary artery bypass surgery. In: Am. J. Surg. 197, 2009, pp. 587-590, PMID 19321157 .
↑ Magee MJ: Fewer grafts performed in off-pump bypass surgery: patient selection or incomplete revascularization? . In: Ann Thorac Surg . 87, No. 4, April 2009, pp. 1113-1118. PMID 19324136 .

[1] German Medical Association , National Association of Statutory Health Insurance Physicians , Association of the Scientific Medical Societies in Germany (eds.): National Disease Management Guideline Chronic CHD - Long version (PDF, 1.5 MB) 2008. Accessed March 28, 2009. ( Page no longer available , searching web archives ) Info : The link was automatically marked as broken. Please check the link according to the instructions and then remove this notice.@1@ 2Template: Dead Link / www.bdc.de

[PMID19321157-2] JM Douglas, SE Spaniol: A multimodal approach to the prevention of postoperative stroke in patients undergoing coronary artery bypass surgery. In: Am. J. Surg. 197, 2009, pp. 587-590, PMID 19321157 .

[3] Magee MJ: Fewer grafts performed in off-pump bypass surgery: patient selection or incomplete revascularization? . In: Ann Thorac Surg . 87, No. 4, April 2009, pp. 1113-1118. PMID 19324136 .