May 2003, Volume 33 Number 5 , p 32cc1 - 32cc3
Benefits and risks of CPB
Cognitive changes and stroke
Atrial fibrillation (AF)
Comparing the risks of OPCAB
Each has its place
Who's right for OPCAB?
For some patients, this older version of cardiac surgery may reduce the risk of surgical complications. Learn what's new about this old-fashioned technique.
Before the advent of the cardiopulmonary bypass (CPB) machine in the 1950s, cardiac surgeons had no choice but to revascularize beating hearts. A major advance in cardiac surgery, the CPB machine kept vital organs perfused while surgeons worked on a motionless heart. This motionless environment also provided protection from cardiac ischemia induced by the procedure. Today, surgical revascularization of the heart is the most frequently performed surgery in the United States and Canada.
During the last 5 to 10 years, surgeons have returned to off-pump coronary artery bypass (OPCAB) surgery for certain patients, especially the elderly. In this article, I'll explain why. I'll also discuss who may qualify for OPCAB surgery and how the risks of CPB and OPCAB surgery compare. First, though, let's look at reasons for the resurgence in OPCAB.
One reason for the new popularity of OPCAB is that this surgery may be especially beneficial for elderly adults, who make up a growing proportion of patients undergoing cardiac revascularization. Typically, the elderly have more medical problems, increasing the risk of CPB-related complications such as stroke.
Data suggest that OPCAB surgery may lower stroke rates for these older patients. Preliminary research also shows that OPCAB surgery entails fewer complications, shorter hospital stays, and ultimately ...