Frequently Asked Questions
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?

What are the benefits of off-pump coronary bypass?

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

What are the criteria for patient selection for OPCAB?

Are high-risk patients appropriate to undergo surgery using the off-pump technique?

What are the indications for OPCAB?

What are the physiologic effects of cardiopulmonary bypass?

What stabilizing devices are used in OPCAB surgery?

What are the technical aids for off-pump anastamoses?

What intraoperative monitoring takes place during OPCAB?

What methods of anesthesia management are used during OPCAB?

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

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

What are the advantages and disadvantages of OPCAB?
Advantages:

• No cardiopulmonary bypass required
• No cardioplegia
• All vessels can be grafted

• 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 methods of anesthesia management are used during OPCAB?

• 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

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