Heart attack typically occurs when flow of oxygen-saturated blood to a region of heart is cut off. Whenever blood flow is not restored in time, specific area of heart muscle eventually dies. Heart attacks need appropriate & quick treatment, as they may lead to other health problems or even death in some cases. According to reports, heart failure & other cardiovascular diseases cause millions of death each year across the globe. Heart failure is a general, disabling & deadly condition caused due to certain coronary heart diseases like angina. Cardiovascular diseases occur more in patients aged between 40 - 75 years.
Young people have comparatively lower chance to suffer from severe heart disease. Off-pump coronary artery bypass surgery or OPCAB & colloquially termed beating heart bypass surgery is a procedure which is performed to lower risk of death from coronary artery disease & relieve angina which is the most common cause of heart failure.
What is Off-Pump Coronary Artery Bypass Surgery?
When traditional treatment alternatives for coronary artery disease are unsuccessful & patients continue to have persisting chest pain or are at higher risk of having a heart attack, cardiologists may refer them to a cardiothoracic surgeon for coronary artery bypass surgery. In most bypass surgeries, the function of heart is stopped & a heart-lung device takes over the work of heart & lungs. Another effective type of bypass surgery that may be suggested is Beating Heart or Off-Pump Coronary Artery Bypass Surgery. This surgery is a type of coronary artery bypass graft (CABG) surgery done without the heart-lung machine; heart is still beating while blockage is removed for treating coronary heart disease.
Various factors can contribute to damaging the innermost layers of coronary arteries & thereby increasing the risk of dreadful conditions. Main causes of coronary artery diseases can be listed as follows.
When patient’s arteries get damaged, plaque might build-up. In addition to the above-stated factors, blood clots formed from ruptured plaque may further block or the arteries, prompting angina & leading to heart attacks.
Following signs & symptoms of coronary artery disease may be an indication of a serious heart condition.
- Hypertension (high blood pressure)
- Excessive smoking
- Elevated level of cholesterol
- Inflammation of blood vessels
- Elevated levels of sugar in blood
Unfortunately, there are no specific symptoms of early coronary artery disease, yet it will progress until severe artery blockage exists to cause the above mentioned signs & symptoms. When this occurs severe conditions of the heart may go undiagnosed until a major cardiovascular event occurs.
All patients who need bypass grafts alone are considered as good candidates for off-pump coronary artery bypass surgery. In case of some patients, use of a heart-lung bypass device can raise risk of stroke & other major complications. Hence, off-pump method is very helpful for such patients. Good candidates for OPCAB surgery are as follows.
- Shortness of breath
- Chest pain
Off-Pump Coronary Artery Bypass Surgery is not suggested in the following cases.
- Elder Patients - Elderly patients over 70 years of age with multiple diseased vessels.
- Kidney Problem - Patients who are on dialysis or have some other kidney disease.
- Lung Disease - Patients with lung disease such as emphysema.
- Stroke - Patients with previous history of stroke or transient ischemic attacks.
- Low Ejection Fraction - Patients with low ejection fraction indicating poor heart function.
- Atherosclerosis - Patients with severe atherosclerosis in aorta.
- Blood Transfusion - Patients refusing blood transfusions.
Surgeons will diagnose coronary heart disease based upon patient’s medical & family histories, their risk factors for coronary heart disease, a physical examination & outcomes from tests. They may also suggest the following diagnostic tests.
- Valve Disease - Patients who have valve disease.
- Enlarged heart - Patients with an enlarged heart condition.
- Severe Blockages - Patients with blockages extending into the heart muscle.
- Long Grafts - Patients who need long grafts.
If any of the above-mentioned tests are positive for coronary artery disease, cardiac catheterization procedure may be done by cardiac surgeons to demonstrate site & level of severity of coronary artery narrowing. Following cardiac catheterization test, surgeons may recommend off-pump coronary artery bypass surgery.
Off-pump coronary artery bypass technique may help patients avoid inflammatory response & certain neurological deficits that are associated with the heart-lung machine. This surgery may offer enumerated important benefits.
- Blood Tests
- Electrocardiogram (EKG)
- Chest X-ray
- Exercise stress test
- Lessening risk of stroke
- Fewer chances of infections
- Reduced risk of kidney failure
- Less requirement for blood transfusions
- Fewer complications associated with lungs
- Lesser injury to heart muscle
- Faster discharge from hospital after surgery
It is important for patients to be aware of OPCAB procedure & risk factors prior to undergoing surgery.
- Initial Medical Session - Doctors will have a detailed discussion of OPCAB procedure with patients. They may enquire about medical history of the patient & in addition to that they may also perform a physical examination of the complete body to ensure that patients are in good health before undergoing surgery.
- Smoking - Patients should stop smoking as soon as possible. This will improve chances for a successful & healthy recovery & will benefit patient’s overall health status as well.
- Drinking - Patients should avoid consuming alcohol in excessive quantities in order to avoid complications following surgery.
- Food Intake - Patients may not be allowed to eat 10 – 12 hours prior to OPCAB surgery. Patients should notify surgeons of any history of bleeding diseases or if they are taking any blood-thinning medicines including aspirin or any medicines that affect blood clotting. It may also be important to stop certain medications prior to surgery.
Main goals of Off-Pump Coronary Artery Bypass surgery are given below.
- Why do you recommend off-pump coronary artery bypass surgery in my case?
- What do I need to understand about OPCAB surgery?
- What is the difference between conventional CABG surgery procedure & off-pump coronary artery bypass surgery?
- Does OPCAB surgery remove blockages completely?
- How soon after OPCAB surgery can I expect to see outcomes?
- How soon can I resume daily activities after my surgery?
- Do I need to take any medications before as well as after my surgery?
- When can I expect to recover entirely following OPCAB procedure?
Off-Pump Coronary Artery Bypass Surgery is performed in following steps.
- To relieve patients of signs & symptoms of cardiovascular diseases.
- Improve flow of blood to heart.
- To accelerate patient’s life.
After completion of off-pump coronary artery bypass surgery, patients will be monitored in an intensive care unit for approximately 24 hours. Patients will likely have to spend 3 - 4 days in the hospital till their condition becomes stable. Common guidelines given by surgeons following off-pump coronary artery bypass surgery include the following.
- Anesthesia - Off-pump coronary artery bypass surgery is performed by cardiothoracic surgeons in an operating room with patients influenced under general anesthesia. This procedure typically takes about 4 hours to complete but may need longer time depending upon the number of bypasses to be performed. During OPCAB, patients are placed lying on their backside. The graft & chest regions are shaved properly & then scrubbed with antiseptic. Generally, surgeons will give general anesthetic to patients so that they will be asleep during surgery.
- Incision - Surgeons will make a long incision down the middle of patient’s chest bone. Precise tools called retractors are used to widen ribs apart in order to enable surgeons to gain access to the heart. At the same time, another surgeon will pull off a vessel from either the patient’s arm or leg & which can eventually be used as graft.
- Graft - Cardiothoracic surgeons may use an artery in chest known as an internal thoracic artery. In such cases, patients will not have a graft site incision on the leg or arm unless they are undergoing multiple bypasses. Surgeons will stabilize the beating heart muscle. This is to allow the surgeon to work on a region with nominal movement but with the heart still functioning & pumping blood throughout the body.
- Completion of Procedure - When an arm or leg graft is used, the surgeon will fix one edge of graft with stitches to the aorta. Another end of the graft is affixed to the coronary artery beyond the bounds of blockage. It bypasses the flow of blood to the blockage & allows the blood to flow freely into the heart muscle. When internal thoracic artery is used, the surgeons will divert the artery by disconnecting its one end & reattaching it under the blockage on coronary artery. After completing these steps, surgeons will finally stitch the incision closed, normally with dissolvable sutures.
Surgeons may prescribe pain medications & blood-thinning medications to prevent blood clots. It is very essential to prevent development of blood clots. It is commonly observed that patients’ feel depressed & have sleep disturbances after OPCAB surgery. However, surgeons will recommend best suitable treatments to get rid of these complications. Daily exercise, lifestyle modifications & healthy diet are important factors for a smooth & speedy recovery following OPCAB surgery.
Several potential risks & complications are involved with OPCAB surgery. Decision to proceed with this surgery entirely depends upon the patient. General complications of OPCAB surgery are listed as below.
- Patients are not allowed to drive for nearly 6 weeks after OPCAB surgery.
- Patients will be instructed on how to care for healing incisions.
- High fatigue is a side-effect of this surgery which can be seen for a couple of weeks after OPCAB surgery. This condition will gradually improve with time.
- There will be activity restrictions on patients like no heavy lifting or strenuous physical exercise for the first 6 - 8 weeks following surgery so as to heal the sternum completely.
Specific complications of Off-Pump Coronary Artery Bypass Surgery
- Adverse reactions to dye, or medications
- Heavy blood loss requiring transfusion
- Kidney failure, heart attack, strokes, bladder infections & pneumonia
- Serious medical issues can lead to prolonged hospitalization or even death in some cases
Risk factors that can elevate chances of severe complications following Off-Pump Coronary Artery Bypass Surgery
- Heart Attack or stroke
- Deep infection necessitating IV antibiotics
- Irregular heart beat
- Blood vessel rupture requiring another revisional surgery
Off-pump coronary artery bypass surgery is remarkably a safe procedure when performed under guidance of experienced cardiac surgeons & a skilled operation team. Patients must find a good cardiologist & a well-versed cardiac surgeon & allow them to perform OPCAB surgery. Subsequently, patients will get relief from persisting heart diseases & will be able to live a healthy life after undergoing this highly reliable surgical intervention.
- History of kidney disease
- Poor cardiac function
- Extensive heart disease
- Poor nutrition
- Steroid Use
- Age factor
- Chronic Illness
Medical Tourism in India for Off-Pump Coronary Artery Bypass Surgery
India has managed to be a leading medical tourism destination providing a wide range of cost-effective medical solutions including cardiac treatments for patients from all around the world. Indian medical industry has gained a position of best healthcare provider due to top-notch quality of cardiac surgeries like off-pump coronary artery bypass. Cardiac surgeons in India are highly reputed & are well-experienced in handling complicated heart surgeries. Top Indian cardiac hospitals provide the following provisions to international patients.
- Availability of tests such as ECG, stress echo & echocardiography
- Well-equipped ICU & recovery rooms for patients
- Modern infrastructure
- State-of-the-art equipment
Off-Pump Coronary Artery Bypass Surgery with Travcure Medical Tourism
Indian hospitals have efficient medical staff, ensuring proper care to global patients seeking off-pump coronary artery bypass surgery. Travcure Medical Tourism is a globally recognized healthcare tourism facilitator which is based in India. Travcure is associated with best cardiac surgeons & the best multispecialty hospitals in the country so as to offer one of the most affordable & hassle-free medical travels to patients from all around the world looking for OPCAB surgery.