There is interest in different ways to doing bypasses in the past few years. They have mostly been classified under the term minimally invasive. Within this term, there are 2 major sections. The first is called OPCAB or off pump coronary artery bypass. You’ve all heard the term that what's old comes back into fashion. This is a similar thing. When bypass first started, people did the connections with the heart beating. Then, to try and do a better or careful connection, they used a pump and did the connection with the heart stopped. Now, some people to going back to doing the bypasses with the heart beating. The second major section is called MIDCAB and involves using smaller more cosmetic incisions. This can be done using the bypass machine and stopping the heart or doing the connection with the heart beating.

With this new interest, there are new devices to help do the surgery. For example, for beating heart surgery, most people use a stabilizer. This is a picture of a common one that we use. The essential component here is this section which looks like the bottom part of a sewing machine. What you do is to put the artery that you want to bypass between those 2 arms so that even though the rest of the heart is moving, the artery between those 2 arms are relatively stable so that you can do the connection to it carefully.

Why do the beating heart surgery? The incisions are usually the same. There may be some benefits to avoiding the use of the pump. There is less bleeding if you don’t have to use the pump. The most important hope is that there is less stroke if you don’t use the pump. This has not been found but one possible reason is that strokes are uncommon, happening in about 3% of cases. If there is a large, for example 50% decrease, in stroke risk from 3% to 1.5%, it would be easy to find a difference. If there is only a 10% decrease in stroke risk from 3% to 2.7%, it would be hard to find. If you did 2,000 cases, 1,000 each way, there would still only be a difference between 30 strokes in one group and 27 in the other. So, there are some benefits to doing beating heart surgery. But, the drawback is that because the connections done with the heart moving may not be as good as the connections with the heart still, the bypasses may not stay open as long. Some people have found that you actually don’t see a difference until 3 years out. Since this is relatively new, a lot of people have 1-2 year data but not long term results. So, the bottom line is that it must be individualized for each patient. If you have someone who is 85 years old and having the grafts stay open for 10 years is not the most important, then beating heart may be the way. On the other hand, if you have someone 65 years old and having the grafts stay open is very important, then standard surgery may be the way.

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