Beating Heart Surgery From Aortocoronary Bypass Surgery to Procedures on Valves

(#2001-09100)

Borut Gersak, MD

Department of Cardiovascular Surgery, University Medical Center, Ljubljana, Slovenia

Introduction:

In the year, 1880 it seemed impossible to operate on a heart˘hence the well-known statement of the surgeon Billroth: "Any man who would attempt to operate on the heart should lose the esteem of his colleagues." Today, however, it is possible not only to operate on a heart but to perform aortocoronary bypass grafts (CABG) without cardiopulmonary bypass (CPB), a procedure known as off-pump CABG (OPCAB). It is also possible to perform surgical procedures through small holes (minimally invasive direct CABG, or MIDCAB) even using computerized visualization and ≥robotic≈ instrument manipulation devices, and to perform valve surgery on the beating heart.

Changes in blood cardioplegia have been equally dramatic, evolving from pure cold crystalloid to warm blood cardioplegia.

Although surgery performed on an arrested cardioplegic heart with CPB is still the gold standard in cardiac surgery, the gold may be turning to silver as off-pump CABG surgery, without cardioplegia and CPB, becomes the procedure of choice in many circumstances.