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Off-Pump Heart Bypass Surgery (OPCABG)

Clip Number: 36 of 41
Presentation: Common Heart Conditions, Tests, and Procedures
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Reviewed By: Arthur Schoenstadt, MD
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After your anesthesia takes effect, your upper body will be washed with a special disinfectant solution, and may also be shaved. You will be covered with sterile sheets, and a catheter -- which is a flexible plastic tube -- will be put into your bladder. Another tube will be placed down your throat and into your stomach.
Your surgeon will begin the surgery by making a 6 to 8 inch incision, or cut, down the middle of your chest. Your breastbone will then be separated, and held open so your surgeon can reach your heart. The heart sac is then carefully opened, and your heart is examined. Your surgeon will look at each of your blocked coronary arteries, and decide which ones can be bypassed.
At this point, your surgeon will take out the graft vessel that will be used to make a new path around the blockage. This graft may come from the mammary artery, which is inside your chest, the radial artery, which is in your forearm, or from a vein in the leg. The choice of which blood vessels are used as grafts will depend on your particular situation.
Your surgeon will then carefully move your heart so that the blocked area is easy to reach, and put the heart stabilizer near the blocked blood vessel. While the movement of the heart in this area is reduced, the graft will be sewn into place. One end of the graft is attached to a healthy blood vessel, and the other end is sewn on below the blocked section of your coronary artery. Blood can now flow AROUND the blockage, so more of it gets to your heart. If you have more than one blocked artery, your doctor will repeat these steps for the other blockages.
After all the grafts have been sewn in place, small, thin wires may be put directly on your heart. These are called "pacing wires," and they help your heart to beat normally. Not everyone needs pacing wires, but if you do, they will be left inside your chest during the first part of your recovery.
The doctor will also put several tubes inside your chest. These drain fluid that may collect near your heart.
After the tubes are in place, your doctor will then close the breastbone and hold it together with strong, steel wires. These keep the breastbone from moving too much while it heals, and they will remain in your body for the rest of your life. Your skin is then closed with stitches, and covered with a clean bandage.
Although your surgeon has recommended that you have beating heart surgery, he or she may decide to use the heart-lung bypass machine after the surgery has begun. This usually happens when the surgeon feels that the heart-lung machine would make the operation safer.

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