About Off-Pump Coronary Artery Bypass (OPCAB)

The off-pump team at Advocate Lutheran General Hospital has been performing OPCAB surgeries since 1999, and performs the highest number of OPCAB surgeries in metropolitan Chicago. As a pioneer in the field of OPCAB surgery, Lutheran General Hospital cardiovascular surgeons use this innovative surgical technique for 96 percent of patients requiring surgical coronary artery revascularization. Physicians who desire to learn more should contact the office of Axel Joob, M.D., and Janice Klich, M.D.

What are the advantages and disadvantages of OPCAB?

Advantages:

No cardiopulmonary bypass required
No cardioplegia
All vessels can be grafted
Disadvantages:
Full sternotomy 

What are the benefits of off-pump coronary bypass?

Patients experience decreased:

Total body inflammatory response
Coagulopathy
Transfusion requirement
Post-operative neuralgic sequelae
Renal dysfunction
Length of stay
Cost 
 

What are the requirements for successful off-pump coronary bypass?

Patient selection
Expert anesthesia
Stabilizing devices
Adequate recipient vessel 
 

What are the criteria for patient selection for OPCAB?

Coronary arteries requiring revascularization
Availability of suitable bypass conduits 
 
Are high-risk patients appropriate to undergo surgery using the off-pump technique?
Yes. Patients who were previously judged to be too high risk to undergo cardiac surgery can be considered. These include patients with severe calcification of the aorta, pulmonary edema, recent myocardial infarction or significant neurologic risk.

What are the indications for OPCAB?

Multivessel disease requiring revascularization
Contraindications or increased risk for cardiopulmonary bypass, such as:
severe myocardial dysfunction;
immunosuppression;
history of transient ischemic attacks or cerebrovascular accidents;
heavily calcified aortas
aortic disease with increased riskof dissection, rupture or embolization
impaired renal function or need for dialysis
history of previous surgery
Patients who refuse blood transfusions and blood products
Other high-risk patients such as those with advanced age, respiratory problems or other systemic disease 
 

What are the physiologic effects of cardiopulmonary bypass?

Neurologic
Renal
Immunologic
Coagulation

What stabilizing devices are used in OPCAB surgery?

Vortex stabilizer system
Octopus stabilizer
Cohn stabilizer

What are the technical aids for off-pump anastamoses?

Coronary vessel loops
Intraluminal shunts
Single limb
Double limb
Triple limb 

What intraoperative monitoring takes place during OPCAB?

Typically, a combination of the following are used on patients undergoing OPCAB surgery:

Arterial pressure montoring
12-lead electrocardiographic (ECG) monitoring
transesophageal echocardiograpy to detect wall motion abnormalities and optimize preload
Assessment of flow velocity and graft patency 
 

What methoof anesthesia management are used during OPCAB?ds

Use of short-acting agents
Aggressive pain control
Single-lung ventilation (of the right lung) to improve access and reduce cardiac movement caused by inflation and deflation of the left lung 

Can all vessels of the heart be safely bypassed using OPCAB techniques?

Yes. With improved technology, including stabilizing devices and intracoronary shunts, as well as close collaboration with anesthetic management, all vessels can be bypassed.

What are the main indications and risk factors for conversion of off pump to conventional coronary artery bypass graft surgery (CABG)?

Hemodynamic instability or compromise during off pump CABG surgery
Inability to access the areas that require revascularization