A Better Bypass
Coronary artery bypass grafting (CABG) might be the standard treatment for Coronary disease, but it comes with an increased risk of post-operative stroke compared to other techniques. However new research suggests that a few tweaks to the technique might decrease this risk, especially for patients whose risk of stroke is higher to start with. Moreover, it might improve a number of common post-operative complications as well. A recent article on this very topic, “Coronary Artery Bypass Grafting With and Without Manipulation of the Ascending Aorta”, written by several of the surgeons associated with The Baird Institute, featured in the February edition of the Journal of the American College of Cardiology (JACC), considered to be the pre-eminent Cardiology journal in the world. In addition, it received some great press overseas with more than 55 news outlets reporting on it in less than a week, following its publication.
This landmark study, led by Professor Michael Vallely involving 37,720 patients, demonstrated that a newer “no-touch” beating heart bypass surgery technique (anOPCABG) reduced postoperative stroke by 78% compared to traditional coronary artery bypass grafting (CABG). In addition, compared to traditional CABG, the newer “no-touch” technique also reduced postoperative mortality by 50%, renal failure by 53%, bleeding complications by 48%, atrial fibrillation by 34%, and length of intensive care unit stay by 13.3 hours.
Professors Michael Vallely and Michael Wilson have done more 1000 anaortic OPCABG cases now, in fact it is their routine CABG procedure. Take a look at Professor Vallely operating on a patient using the anaortic OPCABG procedure. This was produced by the ABC’s Radio National program.
Four surgical methods of coronary artery bypass grafting with increasing degrees of aortic manipulation.
Percentages pictured represent the relative decrease in risk of perioperative stroke using anOPCABG compared to the other techniques
- CABG = coronary artery bypass grafting with cardiopulmonary bypass
- anOPCABG = anaortic off-pump coronary artery bypass grafting; LIMA = left internal mammary artery
- OPCABG-HS = off-pump coronary artery bypass grafting with the Heartstring system
- OPCABG-PC = off-pump coronary artery bypass grafting with partial clamp; RIMA = right internal mammary artery