beating heart surgery
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Beating heart or “off pump” coronary artery surgery is the latest revolution in the management coronary disease. It is being embraced world-wide by increasing numbers of surgeons. Many of the advantages are subtle but reduced mortality, stroke, and bleeding as well as earlier discharge are well-established benefits. A cardiac stabiliser is mandatory for this surgery, most are single use only and very expensive, this one is multiple use and is saving many healthcare dollars.
Beating-heart surgery is a way to perform surgery without stopping the heart. Surgeons use a special device to stabilize the part of the heart on which they are operating. The heart continues to beat and circulate blood to heart muscle during the operation. Surgery on a beating-heart helps reduce the risk for complications associated with temporarily stopping the heart during surgery.
Surgery on a stopped heart is common, and some heart procedures can only be performed on a motionless heart. Physicians use a special solution called cardioplegia to stop the heart.
If the heart is stopped for surgery, the surgeon must restart it and reintroduce blood into the tissue. This is called reperfusion. Reperfusion can cause impairment of heart function. Sometimes, heart muscle tissue can be damaged at the cellular level during reperfusion, a phenomenon known as reperfusion injury. In some people, reperfusion injury can lead to complications such as arrhythmias and heart attacks. Reperfusion injury is especially a concern in high-risk patients, such as the elderly, people who have had several heart surgeries, patients with severe blockages, and those with complex health problems.
Reperfusion injury can be avoided if the heart is kept beating during surgery.
At the University of Chicago Medical Center, our cardiac surgeons opt to perform beating-heart surgery whenever possible. More than 90 percent of coronary artery bypass surgeries performed here are done on a beating heart.
While not all procedures can be performed on a beating heart, our surgeons have developed many techniques that make beating-heart surgery an option for even complex procedures on the inside of the heart–including valve repair. In fact, our surgeons were among the first in the world to perform beating-heart mitral valve surgery. The University of Chicago Medical Center is one of the only hospitals in the nation where beating-heart surgery is being performed to treat valve disease.
Some of the procedures performed on a beating heart include:
Coronary artery bypass graft surgery (including ThoraCAB, a minimally invasive option performed without cutting the breastbone, as well as open-chest, beating-heart bypass)
Surgery for atrial fibrillation
Treatment of some congenital heart defects, such as closure of atrial septal defect
Valve repair (mitral, pulmonary, or tricuspid)
Valve replacement (mitral or tricuspid)
Ventricular reconstruction
More than 70%2 of all bypass surgeries are performed on a stopped heart. Unlike beating heart surgery, during conventional on pump heart bypass, medication is used to stop your heart.
A heart-lung machine takes over the function of your heart and lungs during the surgery.The heart-lung machine is also called a cardiopulmonary bypass machine. It has a pump to function as the heart and a membrane oxygenator to function as the lungs.
Heart-Lung Machine
This mechanical “heart and lungs” keeps oxygen rich blood circulating throughout your body. The heart-lung machine collects the blood. Carbon dioxide and other waste products are removed. The oxygenator adds oxygen, and the oxygenator’s heat exchanger warms (or cools) the blood. The blood is gently circulated back through the body. This process is called perfusion. The person who operates the heart-lung machine is the perfusionist.
Stopping Your Heart
Your heart will usually be stopped for about 30-90 minutes of the 3-6 hour surgery. The heart-lung machine makes it possible for the surgeon to work on a still heart. This technique has been used for many years with excellent results. Once the surgery is over, the surgeon and perfusionist restart your heart.
Medtronic Perfusion Systems
Medtronic creates the dependable perfusion systems that make on pump surgery possible. We are committed to providing doctors, hospitals, and patients with reliable, technically advanced equipment.
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