BEATING HEART BYPASS SURGERY

Heart-lung machine (cardiopulmonary bypass machine) was introduced into clinical practice in 1953 and has been the backbone of modern cardiac surgery since then. The pump however is still an artificial blood circulation device made up of tubes and artificial surfaces. The possible adverse effects related to the ‘pump’ has been long recognized by surgeons however these side effects were accepted since there was no alternative at the time. The heart lung machine was proven to be the most significant factor in the morbidity following open heart surgery. The pump has been known to cause sometimes permanent disturbances in some of the vital organs such as brain, kidneys, heart and the liver. These ill effects are better recognized as more detailed analysis of the end-organ damage due to the heart lung machine is performed. Despite improvements in the pump technology, it still far from being an ideal blood circulation circuit to match body’s own.

Beating Heart Bypass Surgery has been utilized in South America since 1980’s. A group of surgeons started to use this technique in the early 1990’s. The number of beating heart bypass procedures increased with increasing applicability of this technique to wider population of patients and as the benefits of this technique is increasingly realized. Beating heart bypass surgery comprises more then 50% of coronary artery bypass surgeries in some centers and makes up close to 100% of all bypass procedures in some countries.

The short term and long term effects of this procedure ahs been studied in thousands of patients and beating heart bypass procedure was shown to result in a significant decrease in the number and severity of complications of coronary artery bypass surgery.

Beating heart bypass surgery has been shown to be especially beneficial in patients who are over 60 years of age, diabetes and poor heart muscle function. These patients have been shown to have decreased bleeding, kidney failure, heart attack, stroke and death risk if bypass is performed using beating heart bypass.

The concerns regarding the difficulty of the surgical procedure has been proven to be unnecessary since the patency of bypass grafts and short and long term outcome of the patients have been similar to the classical bypass procedure using the heart lung machine.

The most important benefit of avoiding the heart lung machine is perhaps reduction of central nervous system side effects like stroke, coma, encephalopathy and cognitive dysfunction. It has been proven that use of the heart lung machine during open heart surgery is the biggest risk factor for development of stroke and encephalopathy. There is also a 10 fold increase in the number of embolic materials (blood clots, calcium and cholesterol from the aorta, fat particles, plastic material from the pump system and air) detected in the brain arteries during bypass surgery when using the heart lung machine compared to the beating heart bypass technique. The long term ill effects of such increased embolic load in the brain have been linked to delayed cognitive dysfunction and mental deterioration observed commonly years after classic bypass surgery.

There is no doubt beating heart bypass procedure requires strenuous training, vast experience and excellent skills. Therefore, beating heart bypass surgery should be performed only by skilled surgeons who have adequate background in terms of training, track record, and results.

Dr. Gurbuz started beating heart bypass surgery program in Tucson Arizona in 2000 while in the United States and has performed over 1000 bypass procedures using this technique with excellent results. He trains surgeons from abroad and has published his experience in the most prestigious North American and European medical journals. He has also appeared in the US media and TV programs as well as in Turkish media and several TV programs regarding this technique.