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POST OPERATIVE OBSERVATIONS

In beating heart CABG, extubation may occur earlier than usual – often in the OR. Beating heart CABG also results in a shorter length of ICU stay and overall hospital stay.3 In general, beating heart CABG allows the patient to return to activity and normalcy much earlier than patients on CPB.3,23

"It's pretty easy to go upstairs and point at the patients that have been on pump and the patients that have been off pump."13 -James C. Hart, M.D.
"The patients respond to [beating heart CABG] so much better and are extubated within 26 hours."13
-David Perkowski, M.D.
"I saw my two post-op patients today in the unit. Both were awake, smiling, no bleeding, no strokes, sitting up, and delined. As they sat up, swung their legs over the side of the bed, and begged me to listen to how good their lungs sounded, they told me how appreciative they were. I could not think of another time EVER that an on-pump patient had EVER looked this good this quickly." 24 -Michael D. Moran, M.D., Cardiologist

CONCLUSION

The treatment of ischemic heart disease in the modern era has been revolutionized with the advent and mastery of CABG. This treatment modality provides enduring results unequalled by medical therapy or transcatheter interventions. However, CPB-related problems occur when CABG is performed with CPB:

  • Microemboli with neuropsychological sequelae
  • Coagulopathy and bleeding
  • Immunosuppression
  • Systemic inflammatory response with its associated deleterious pulmonary, renal, and gastrointestinal effects

These CPB-related problems, in combination with the access trauma of the traditional surgical approach, increase the risk for all patients (to the point of excluding some patients as surgical candidates) and cause some patients to opt for less enduring transcatheter interventions. Reduction of CPB-related morbidity through the use of beating heart CABG:

  • Allows even the highest-risk patients to undergo CABG
  • Makes enduring CABG an attractive modality to the lowest-risk patients
  • Allows a faster recovery for all patients

Rapid evolution of enabling technologies has accompanied refinement of beating heart CABG techniques, thus extending the superior benefits of CABG to increasing numbers of patients. Developments in minimal access surgery, including three-dimensional video assistance and computer robotics, will allow a marked decrease in the access trauma usually associated with CABG. The coupling of these techniques with beating heart CABG (and its reduction in the CPB-related morbidity) represents an exciting frontier in cardiac surgery.

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