PERFORMING THE NEW OPCAB MINIMALLY INVASIVE BYPASS SURGERY: Stony Brook Selected as National Training Site

Coronary artery bypass grafting (CABG) is the most commonly performed major operation in the United States, with about 600,000 patients undergoing this procedure each year. Adverse side effects associated with use of the heart-lung machine—which, during conventional CABG, takes over the stopped heart's work—can now be avoided with the newly developed procedures known as "beating heart" or "off pump" bypass surgery.

Currently, there are two such procedures: MIDCAB and the latest advance, OPCAB; that is, minimally invasive direct coronary artery bypass and off-pump coronary artery bypass, respectively.

At Stony Brook, our use of these minimally invasive off-pump techniques has grown significantly. In 1997, less than 5% of all our bypass operations performed here were off-pump procedures, and in 1998 that percentage grew to nearly 25%.

We have developed minimally invasive bypass surgery to a level that is true of only a few institutions in the country. Now, with OPCAB, we can offer multi-vessel—four- or five-vessel—bypass without the use of the heart-lung machine. The benefit to the patient generally is a shorter time in the hospital, a quicker recovery at home, and an apparent reduction in associated risk of complications.

Dr. Frank C. Seifert, associate professor of surgery, who has gained national recognition for his skills in performing off-pump bypass procedures, leads our Division of Cardiothoracic Surgery in minimally invasive heart surgery, including the new OPCAB.

In August 1998, Stony Brook's Heart Hospital was selected as a national preceptor training site for teaching the operative techniques of off-pump multi-vessel CABG because of the high volume of this novel surgery performed here by Dr. Seifert. We are one of only 15 sites nationwide, all of which are sponsored by CardioThoracic Systems, a pioneering corporation in the development of minimally invasive cardiac surgery treatments.

Practicing cardiac surgeons from all over the Northeast now visit Stony Brook once a month to observe Dr. Seifert perform OPCAB.

Off-pump techniques for multi-vessel bypass surgery have been used at Stony Brook since September 1997, and have been evolving since then. According to Dr. Seifert, analysis of our experience with them shows confirmed reduction in blood utilization, confirmed shortening of hospital stay, an apparent reduction in stroke rate, and an apparent reduction in mortality.

What It Is

With regard to surgery, "minimally invasive" can mean nothing more than use of a smaller incision. It can also mean treating a disease effectively with minimal disruption to a patient's physiology, or vital processes.

Off-pump surgery is a technique that allows the surgeon to perform a bypass procedure without the use of cardiopulmonary bypass (CPB) via the heart-lung machine. Consequently, patients do not experience the inflammatory response caused by CPB, which disrupts the body's physiologic balance.

Conventional open-heart procedures are performed after the heart is stopped and the patient is put on CPB. During both MIDCAB and OPCAB, the patient's heart continues beating, and the surgeon uses a device to stabilize the portion of the heart where CABG is needed.

While the advent of CPB was a major breakthrough in the field of cardiac surgery, there are serious issues associated with its use. In addition to an increased risk of stroke, other potential neurologic problems must be considered as well, such as difficulties with memory and understanding that can affect some patients.

The potential benefits of having an off-pump bypass procedure include reduced trauma; reduced risk of bleeding, stroke and renal failure; reduced psychomotor and cognitive problems; reduced hospital stay; and reduced postoperative complications.

Unlike the MIDCAB procedure which is performed through a thoracotomy (an incision between the ribs), the OPCAB procedure is surgery that utilizes a traditional sternotomy (an incision through the ribcage).

Which procedure is used depends on the number and location of bypasses that need to be performed. In both the MIDCAB and OPCAB procedures, patients receive general anesthesia, and a breathing tube is inserted so that a ventilator can provide oxygen and assist in breathing. During surgery, portions of the beating heart are steadied with a stabilizer foot.

The OPCAB approach, as noted above, is utilized when there are multiple vessels to be bypassed.

In 95% of patients referred to him for CABG, Dr. Seifert has been able to treat them with off-pump procedures. Last year, he performed 200 OPCAB and nearly 100 MIDCAB operations.

For more information about OPCAB and other minimally invasive heart surgery at Stony Brook, please call 631-444-1820 to arrange for a consultation/appointment with one of our cardiothoracic surgeons.