Patient selection and technical considerations for off-pump coronary surgery

Amit N. Patel, MD, MS, Federico Benetti, MD, and Baron Hamman, MD

From the Departments of Surgery (Patel) and Cardiothoracic Surgery (Hamman), Baylor University Medical Center, Dallas, Texas; and the Benetti Foundation, Buenos Aires, Argentina (Benetti).

Corresponding author: Amit N. Patel, MD, MS, Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, Texas 75246 (e-mail: anpatel72@hotmail.com).

The first successful operations on the coronary arteries were done without the assistance of extracorporeal circulation. Many published reports described operations performed while the heart continued beating.. Advances in cardiopulmonary bypass technology, myocardial protection, and cardiopulmonary support allowed surgeons to operate on these arteries with greater precision.

But what is old is new again. The option of not using the pump was the underlying assumption in the development of the concept of minimally invasive coronary surgery. Reports regarding systemic effects of CPB abound in the literature of the past 17 years. Such effects include hematologic, metabolic, pulmonary, cardiac, and cognitive dysfunctions.

This article reviews the development of minimally invasive coronary surgery and discusses indications and operative steps for beating-heart coronary surgery.