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Beating Heart Surgery

Synonyms: Minimally Invasive Heart Surgery, Keyhole Heart Surgery, Minimally Invasive Direct Coronary Artery Bypass (MIDCAB), Off-Pump Coronary Artery Bypass (OPCAB), Robot Assisted Coronary Artery Bypass (RACAB)

What is Beating Heart Surgery?

Beating Heart Surgery is a novel and revolutionary procedure which is performed while your heart is still beating. Beating Heart Surgery is different from traditional Coronary Artery Bypass Grafting as the heart-lung bypass machine is not used by your surgeon. Beating Heart Surgery does use the Open Heart Surgery approach as an incision is made to cut through the sternum. The most significant advantage of Beating Heart Surgery is that it reduces the risks and post-operative complications that are associated with temporarily stopping the heart during Open Heart Surgery.

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What are the variants of Beating Heart Surgery?

  • Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) - In this procedure, a mini thoracotomy or mini-sternotomy is performed i.e. a small incision (key hole), about 6 - 10 cm long is made. This approach is used only if there are 1 or 2 coronary arteries that need to be bypassed. This approach of Beating Heart Surgery takes about 3 - 4 hours.
  • Off-Pump Coronary Artery Bypass (OPCAB) - In this procedure, the surgeon makes a 12 - 14 cm long incision and opens the breast bone (sternotomy). Using this approach, the surgeon can bypass more than two coronary arteries.
  • Robotic Assisted Coronary Artery Bypass (RACAB) - In this procedure, a robotic device is used to perform coronary artery bypass without cutting through the breast bone. RACAB is a Minimally Invasive Procedure for Coronary Artery Bypass.

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Who is an ideal candidate for Beating Heart Surgery?

If you are an older individual who is at risk for a heart attack or arrhythmias, if you have increased risk of or history of stroke, lung complications, kidney complications, problems with mental clarity and memory, if you have medical conditions such as diabetes, hypertension, if you have poor physical health, if you need Coronary Artery Bypass Grafting, Heart Valve Replacement or surgery for Congenital Heart Disease like Atrial Septal Defect, Ventricular Septal Defect, Valvuloplasty, then you are an ideal candidate for Beating Heart Surgery.

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What does the procedure for Beating Heart Surgery involve?

Beating Heart Surgery is done under general anesthesia. Depending on the approach, either Minimally Invasive Direct Coronary Artery Bypass (MIDCAB), Off-Pump Coronary Artery Bypass (OPCAB) or Robotic Assisted Coronary Artery Bypass (RACAB), the surgery may take approximately 3 - 5 hours. Beating Heart Surgery is performed without the heart-lung bypass machine. However, surgeons may use the machine to boost circulation under certain circumstances. During Beating Heart Surgery, a mechanical stabilizer is attached to the heart to slow it down. With the Beating Heart Surgery, bypass can be constructed for any number of blocked coronary arteries of the heart.

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How do I prepare for Beating Heart Surgery?

Before your Beating Heart Surgery, you will have a complete and through evaluation by your physician, cardiac surgeon and anesthesiologist. All the routine pre-operative tests like blood and urine examination, Electrocardiogram, Echocardiogram, Cardiac Catheterization, and Coronary Angiogram will be performed. Please make sure to inform your doctor about all the prescription and non-prescription medications including vitamin, mineral and herbal supplements that you might be taking. You will be instructed to eat a balanced diet, do some exercises to clear your lungs and quit smoking completely before the Beating Heart Surgery. Also, plan on staying in the hospital for 5 days or so and arrange for someone to help you around the house for the next couple of weeks after Beating Heart Surgery. Do not eat or drink anything for at least 12 hours before the surgery and get a good night's sleep. You will be instructed to shower both on the evening before as well as the morning of surgery with a special antibacterial soap to prevent infection during and following Beating Heart Surgery.

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What to expect during the recovery period following Beating Heart Surgery?

The initial few days following the Beating Heart Surgery can be crucial. There will be pain and discomfort which can be relieved by pain medication. Some of the common unpleasant experiences after Beating Heart Surgery will be forgetfulness, mood swings, lack of energy, tiring easily, lack of appetite possibly even nausea or constipation, difficulty sleeping through the night or perhaps nightmares or vision changes. Your doctor will provide you with a list of specific instructions to follow for the first three weeks at home, after your Beating Heart Surgery to help you return to a normal pace of life. Some of the post-operative Beating Heart Surgery guidelines will include:

  • Pace yourself - get lots of rest and sleep, this will help you heal and recover quickly.
  • Avoid extreme temperatures i.e. very cold and very hot weather including wind chill factor and humidity.
  • Do not perform strenuous activities like lifting, pushing, pulling, mopping, vacuuming, yard work, car washing, laundry etc.
  • Eat a well balanced, low salt, low calorie, nutritious diet comprising of fruits, vegetables, dairy and protein.
  • Avoid alcohol and limit your caffeine intake.
  • Continue coughing and deep breathing exercises.
  • Bathe or shower daily with warm water.
  • Keep your incision clean, do not apply oils, lotions or creams over your incision.
  • Avoid driving or going for long outings.
  • Avoid sexual intercourse for at least 4 - 6 weeks after Beating Heart Surgery.
  • Avoid constipation, eat lots of fruits and vegetables and drink plenty of water to keep your stool soft.
  • Follow the Cardiac Rehabilitation Program as outlined by your health professional team to provide emotional support and information about the recovery process.
  • Make long term lifestyle changes like regular walking, exercising, eat low fat, low calorie diet, quit smoking etc - in short make healthy lifestyle choices.

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What is the outcome of Beating Heart Surgery?

Patients undergoing Beating Heart Surgery typically recover quickly and experience less pain and disconfort. Beating Heart Surgery is technically demanding and requires a team of healthcare professionals with specialized skills and training. Since the size of the incision is much smaller than the traditional CABG operation, there are less chances of bleeding, infection of the incision and post-operative pain following Beating Heart Surgery.

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B . R . A . N . D . of Beating Heart Surgery

Benefits of Beating Heart Surgery

  • Beating Heart Surgery has several benefits, for example there is quicker recovery, short hospital stay, you will experience less trauma due to elimination of heart-lung machine and fewer serious intra-operative or post-operative complications like stroke, bleeding, kidney failure and heart attack.

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Risks of Beating Heart Surgery

  • Damage to heart muscle due to lower blood pressure and diminished perfusion of cardiac tissue.
  • Heart Arrhythmias
  • Possibly transient brain injury (Stroke)
  • Heart Attack
  • Kidney failure

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Alternatives to Beating Heart Surgery

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Now or Never

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Decision to have Beating Heart Surgery

  • The small incision size in Beating Heart Surgery may make access to the heart slightly difficult and limited for the surgeon however, it is certain that you will make a speedier recovery following the surgery. Beating Heart Surgery may offer an earlier return to work and other activities as compared to traditional Open Heart Surgery.

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Keywords: Minimally Invasive Surgery, Coronary Heart Disease (CHD), Coronary Artery Disease (CAD), Heart-lung Bypass, Ischemic Heart Disease (IHD), Valvular Heart Disease, Artificial Heart Valves, Arrhythmia, Stroke, Congestive Heart Failure, Heart Attack, Kidney Failure

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