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Affordable Off-Pump Coronary Artery Bypass (OPCAB) Surgery in India

Off-Pump Coronary Artery Bypass technique is generally known as OPCAB. This procedure is quite similar to the traditional CABG procedures (Coronary Artery Bypass Grafting). OPCAB also uses medial sternotomy for approach, but skipping the important cardiopulmonary (heart-lung) bypass machine during the operation. Development of this off-pump coronary surgery procedure is aimed at decreasing incidences and/or severity of adverse results happening due to extracorporeal circulation. Off-pump surgery up till now has shown improved outcomes among patients at risk of aortic cross-clamping & cardiopulmonary bypass. Cardiac surgeons normally suggest OPCAB when the patient profile fits the case through preoperative work-up & intraoperative findings.

Off-Pump Coronary Artery Bypass (OPCAB) Surgery

Benefits of Off-Pump CABG (Coronary Artery Bypass Graft)

 

Cardiopulmonary bypass process & cardioplegia normally provide a motionless field which eventually facilitates eventual manipulation of heart. It stabilizes the anastomotic site while guaranteeing quality of anastomosis while providing myocardial protection during cross-clamping. However, blood contact through the heart-lung machine circuit for prolonged periods of time is found to induce a systemic inflammatory response along with impaired hemostatis. On pump CABG procedure has shown to produce more significant elevation of the following cellular, molecular & biochemical inflammatory markers when compared to the OPCAB procedure.

  • On-pump CABG is associated with microembolisation of gas & particles from lipids & blood constituents as they cycle through the heart-lung machine.
  • Disturbances in hemostasis following traditional CABG has been demonstrated by lower plasminogen, lower platelet counts & higher D-dimer levels following surgery.
  • Complement, activated through classical & alternative pathways include xanthine, urinary hypoxanthine, malondialdehyde, leucocytes, interleukin-6, interleukin-8, interleukin-10, elastase, C-reactive protein & tumor necrosis factor a as markers of oxidative stress.
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Development of OPCAB or Off-Pump CABG

 

Development of OPCAB was generally based on decreasing incidence and/or severity of adverse outcomes derived by eliminating extracorporeal circulation. Moreover, OPCAB has clinically demonstrated to improve outcomes which include the following benefits:

  • Reduced incidence of stroke & cognitive problems
  • Lesser renal dysfunction
  • Reduced inflammatory response
  • Lesser coagulopathy & requirement of blood transfusion
  • Reduced length of time in intensive care & hospital stays
  • Reduced morbidity & mortality rates

 

Indications for OPCAB Procedure

 

OPCAB or Off-Pump CABG procedure has passed significant learning curve for anesthetists, operating theater staff & cardiac surgeons as well. Multiple bypasses by OPCAB now cover all territories of heart including intracoronary shunts & stabilizing devices which are possible with help of the current technology. However, there are two essential techniques which are available in OPCAB & which depend upon the number & location of coronary arteries requiring to be bypassed. MIDCAB approach is normally performed through mini thoracotomy which is mainly meant for anteriorly located one or two blood vessel disease.

 

General Indications for OPCAB include the Following

 

  • Coronary artery disease which is requiring surgical revascularization
  • Heavily calcified aorta or severely atheromatous
  • High risk of contraindications for heart-lung bypass & aortic cross-clamping
  • Aortic disease with risk of embolization, rupture or dissection
  • Recent myocardial infarction
  • Impaired left ventricular function
  • Hemodynamic instability
  • Target vessels in poor quality including calcified coronary vessels, diffusely diseased vessels & intramyocardial vessels
  • History of cerebrovascular accidents or transient ischemic attacks
  • Patients refusing blood transfusions
  • Impaired renal function or requirement of dialysis in patients with chronic renal failure
  • Elderly patients, or patients with respiratory conditions or patients with systemic disease who are considered high risk surgical patients due to presence of co-morbidities & reduced functional capacity.

 

Traditional On-Pump Coronary Artery Bypass Graft Surgery

 

When people have coronary artery disease (CAD) involving one or more blockage of one or more blood vessels feeding the heart, it is the best time to undergo coronary artery bypass surgery. Desire to improve outcomes following surgery along with advances in technology has led to cardiac surgeons performing coronary artery bypass surgery without the heart-lung bypass machine. OPCAB surgery procedure is also known as Off-Pump Bypass or ‘Beating Heart’ Surgery. Coronary artery bypass surgery is traditionally performed with help of the heart-lung machine. Cardiopulmonary bypass allows the beating of the heart to be stopped so that cardiac surgeons can operate on a still & blood-free heart surface. Despite lacking heartbeats, the heart-lung machine maintains blood circulation throughout the patient’s body after removing carbon dioxide from blood & replacing it with oxygen. Beyond doubt, the heart-lung machine has saved countless lives across the world.

 

OPCAB for Improving Outcomes of Coronary Artery Bypass Surgery

 

OPCAB or off-pump CABG surgery differs from the conventional approach because heart-lung machine is no more used. Instead of stopping the heart, new types of technological advancements & operating equipments now allow cardiac surgeons to hold & stabilize sections of the heart during the operation. With particular areas of heart stabilized, cardiac surgeons can go ahead to bypass blocked arteries in a controlled operative environment, whereas in the meanwhile, rest of the patient’s heart keeps on pumping & circulating blood to all parts of the body. However, OPCAB surgery can only be performed in certain patients with CAD. Nevertheless, all arteries of heart can now be bypassed through the OPCAB procedure with the present state of technology that is available. OPCAB can be the ideal treatment for certain patients who are at increased risk for complications arising out of the heart-lung bypass procedure, like those patients who are having compromised renal or pulmonary function, liver cirrhosis or heavy aortic calcification. Therefore, not all patients are ideal candidates for OPCAB surgery. Determination of a patient who can undergo off-pump procedure is made at the time of operation when the cardiac surgeon is able to evaluate the heart & arteries more closely.

 

Affordable Off-Pump Coronary Artery Bypass (OPCAB) Surgery in India

 

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Over the past few decades India has emerged as a leading global medical tourism destination providing a wide spectrum of affordable healthcare solutions including cardiac treatments for people from all around the world. Although rising costs of healthcare within the developed world has immensely helped the Indian healthcare industry come up as a strong contender, the quality of surgery & the expertise of doctors & surgeons in the country have also contributed to attain this high spot. Cardiac surgeons in India are globally reputed & some of the best, with many of them having initially trained & experienced for decades in advanced countries like Australia, UK, Canada & the United States before returning to their homeland.

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