Beating heart coronary bypass surgery explained

Written by: Mr Alberto Albanese
Published: | Updated: 28/02/2022
Edited by: Sophie Kennedy

Beating heart coronary bypass surgery, also referred to as off-pump bypass surgery, is an innovative technique in the surgical treatment of coronary artery disease that offers improved outcomes for patients. In this informative article, leading consultant cardiothoracic surgeon Mr Alberto Albanese offers expert insight on how the modern procedure differs from more traditional surgical techniques as well as detailing the risks and benefits for cardiac surgery patients.



What is beating heart coronary bypass surgery?

The coronary arteries deliver nutrients and oxygenated blood to the heart. If you have coronary artery disease in which one or more blood vessels feeding the heart are blocked, you may be able to manage your condition with only lifestyle changes or medication. For some patients, a medical procedure called coronary angioplasty, also known as coronary stenting, is also advised.


However, if your disease is severe and involves many blood vessels, you may be facing coronary artery bypass surgery. This surgery was traditionally performed with the assistance of the cardiac pulmonary bypass technique. This uses a machine, often called a heart-lung machine, which allows the heart to be stopped during the procedure so that the surgeon can operate on a surface which is still and blood-free. The heart-lung machine maintains life despite the lack of a heartbeat. It removes all of the toxins and replaces them with oxygenated blood before pumping the blood back to through the patient’s body.


The heart-lung machine has historically saved many lives. However, innovative techniques now allow for the heart to continue to pump during surgery in a procedure known as beating heart coronary bypass. This modern method is also sometimes referred to as an off-pump bypass procedure, as the traditional heart-lung machine is not used.



How does it differ from traditional bypass surgery?

Off-pump coronary bypass surgery differs from a traditional coronary artery bypass graft operation because the heart-lung machine is not used. Rather than stopping the heart, technological advances have created a new kind of operating equipment which allows the surgeon to hold and stabilise portions of the heart during surgery. With a particular area of the heart stabilised, the surgeon is able to perform a bypass to the blocked artery in a highly controlled operative environment. Meanwhile, the rest of the heart keeps beating and pumping blood so it continues to circulate around the body.


With the present technology, in theory, all arteries of the heart can be bypassed off-pump. The vast majority of patients needing coronary bypass surgery may be suitable for the innovative, beating heart technique. It is ideal for certain patients who are at increased risk of complications from the heart-lung machine traditionally used. Such patients may be those with heavy aortic calcifications, pre-existing liver failure or compromised pulmonary or renal function.


Not all patients, however, are good candidates for off-pump procedures. The suitability of the patient for this technique is established during the pre-surgical assessment but the final decision is made intra-operatively when the heart and arteries are evaluated and assessed more closely.



What are the advantages?

The aim of off-pump surgery is to decrease likelihood of fatality and complications associated with traditional coronary artery bypass surgery. These complications can include stroke, kidney or lung failure and the need for blood transfusion.


Recently, specialists are looking with great interest at the possibility that off-pump surgery may reduce the risk of a further complication of more traditional techniques which use the heart-lung machine. This complication relates to cognitive and mental changes which have been seen in many patients who have undergone an on-pump coronary artery bypass graft procedure.



What are the risks and side effects?

The beating heart coronary bypass surgical technique is, in principle, more challenging and more demanding for the surgeon because the heart keeps beating throughout. Therefore, the main potential risk is graft failure. However, with advanced modern technologies and increased surgical experience, this risk is now extremely low. There are few side effects to off-pump procedures but there are great advantages.



What can a patient expect during recovery from beating heart coronary bypass surgery?

A patient should be able to recover quickly after off-pump surgery compared with the traditional on-pump technique. Off-pump beating heart surgery has a reduced risk of general complications as well as shorter intensive care and overall hospital stays. The likelihood that the patient will need a blood transfusion is also lower.


In summary, beating heart coronary bypass surgery offers quicker recovery, great benefits and fewer complications and risks.



If you are seeking treatment for coronary artery disease or would like more information, don’t hesitate to visit Mr Albanese’s Top Doctors profile.

By Mr Alberto Albanese
Cardiothoracic surgery

Mr Alberto Albanese is a versatile and highly experienced consultant cardiothoracic surgeon in London and Essex. Practising at private clinics in London and Essex, Mr Albanese specialises in coronary artery bypass graft, aortic valve repair and replacement, mitral valve repair and replacement, aortic root replacement, and notably beating heart surgery and keyhole surgery.

Mr Albanese first qualified for medicine in Italy, receiving his Laurea from Universita degli Studi di Palermo. It was in Italy where he first trained as a heart surgeon. He then moved to the United Kingdom and continued his training and honing his practising skills in cardiothoracic surgery. Mr Albanese undertook fellowships at well-known units such as Harefield Hospital, St George's Hospital, and the new Barts Heart Centre. Whilst training, he gained a deep experience in all aspects of cardiothoracic surgery and cardiology.

Due to his great passion and dedication to his field, Mr Albanese has several publications in peer-reviewed journals; has attended nationally and internationally meetings and conferences, often as a speaker; and has vast working experience in both Italy and the UK. He is internationally recognised for these reasons.

Mr Albanese has, to-date, performed several hundreds of open heart procedures, maintaining outstanding results. Mr Albanese puts his patients first in all facets, and he holds a very high satisfaction level amongst his patients. This can be noticed in his commitment to visitng other cardiac units, where he attends multi-disciplinary meetings with cardiologists, in which complex patients or difficult cardiac scenarios are discussed in order to ensure the best quality care for every patient.

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