Early Outcomes of Beating Heart CABG

Patients realize substantial benefits when undergoing beating heart CABG. Clinical studies comparing outcomes of beating heart CABG and CABG with CPB have reported that patients undergoing beating heart CABG have benefitted in the following ways:

• Shorter postoperative hospital stays7,8,9
• Shorter time with ventilatory support10,11
• Less blood loss and need for transfusions12,13,14
• Less likelihood of low output syndrome15
• Reduced systemic inflammatory response16
• Fewer arrhythmia and neurologic postoperative complications17
• Potential cost savings18,19

Importantly, research has indicated that beating heart CABG is not associated with increased rates of mortality20,21,22,23 or perioperative myocardial infarction24,25,26 when compared to CABG with CPB.

Beating Heart Surgical Approaches

MIDCAB**

Figure 2. Left Anterior Thoracotomy

Minimally Invasive Direct-Vision CAB: In this surgery a small anterior thoracotomy is done, most commonly on the left side to provide access to the LAD and LIMA. The incision can also be made on the right side for access to the right coronary artery (RCA). A small thoracoscopic port is sometimes used to help dissect the internal mammary artery. The attractiveness of this approach to grafting the heart is a small incision with potential for rapid recovery.27 It is sometimes referred to as accomplishing a "large surgery with a little incision." However, as physicians, we know that what counts is not the size of scar, but long-term results.

Surgeons have rapidly discovered that it can be very difficult to operate through a small incision, particularly when bleeding limits the visibility. In addition, this incision limits access to multiple vessels. Multivessel access and improved visibility are two primary reasons for the growth of the OPCAB procedure.

OPCAB*

Figure 3. Median Sternotomy

Off-Pump CAB (OPCAB): This surgery is now the more frequently used technique. The full sternotomy has the advantage of providing wide exposure and access to all coronaries. However, it does not eliminate problems such as wound pain, healing, and time for recovery.