Beating-Heart Surgery
- What is beating-heart surgery? Why is it performed?
- What are the advantages of beating-heart surgery?
- What kind of surgeries are performed on a beating heart?
- Is a heart-lung bypass machine used during beating-heart surgery?
- Is beating-heart surgery widely available? Do most cardiac surgeons perform beating-heart procedures?
Q. What is beating-heart surgery? Why is it performed?
A. 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.
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Q. What are the advantages of beating-heart surgery?
A.
- Better preservation of heart function
- Better survival rate, especially among high-risk patients
- Reduced hospital stay
- Quicker recovery
- Less chance for heart rhythm, kidney, or liver complications
- Reduced risk for neurological injury, including stroke and memory complications
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Q. What kind of surgeries are performed on a beating heart?
A. At the University of Chicago, 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 Medicine 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
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Q. Is a heart-lung bypass machine used during beating-heart surgery?
A. Beating-heart surgery is often described synonymously with "off-pump surgery," or surgery performed without the use of a heart-lung bypass machine. However, this is not always the case. While it is true that most beating-heart procedures (especially coronary artery bypass surgeries) are performed without the heart-lung bypass machine, surgeons do use the machine to boost circulation during select procedures or cases. Some surgeries can only be performed with the aid of the heart-lung bypass machine.
Surgery with the heart-lung bypass machine has been associated with a slight increase in the risk for complications such as stroke and memory problems. Yet it's important to note that heart-lung bypass machines have been in use for many years, with several improvements in technology making the machines better than ever. If your surgery requires the bypass machine, be assured that our surgeons are experts is using this life-saving equipment.
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Q. Is beating-heart surgery widely available? Do most cardiac surgeons perform beating-heart procedures?
A. Beating-heart surgery is technically demanding, requiring specialized skills and training. Therefore, many surgeons prefer not to do surgery on a beating heart. However, since the late 1990s, beating-heart surgery has gained favor among leading surgeons around the world, especially for coronary artery bypass surgery. University of Chicago cardiac surgeons were among the first to see the benefits of this advanced surgical approach, and they continue to refine and develop new beating-heart procedures.
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