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New Advances in CABG


OPCAB was developed from the minimally invasive school of thought, so the basic premise is to reduce incision sizes and patient discomfort. During this procedure, the heart is not stopped (no cardioplegia) and heart lung machine is not used.

The heart and lungs continue their normal function while CABG is being performed. This is also called Beating Heart CABG. With the heart still beating, there is a greater difficulty in performing a bypass and is more time consuming and most importantly requires greater surgical skills.

There are many advantages of off pump CABG namely lower risk of strokes, faster recovery from surgery resulting in shorter ICU and hospital stay. In high risk patients with impaired kidney function, poor heart function or Redo CABG (second time) this surgical technique is better as it provides protection to the heart.

John Puskas

Dr. Kamales Kumar Saha with
Dr John Puskas, pioneer of
Arterial OPCAB

All arterial Grafts

What is very crucial for the long term success of CABG is what is being used as a graft to bypass the blocked coronary artery. Most surgeons use veins from legs for this purpose and this leads to blocked grafts within a few years. But the use of arteries from the chest and hand for bypassing the blocked coronary arteries can help avoid this. This is called All Arterial CABG.

It has been conclusively proven by studies that chest arteries (IMA) have better patency than veins and even drug coated stents.

Stents have the added drawback that they are more costly in case of multiple artery (multivessel) disease. The patency of arterial grafts is more than 15 years whereas average patency of veins is 5 years. Another unique advantage of arterial grafts is that the flow in these grafts increase with time and exercise. So ‘All Arterial CABG’ is a better choice in multivessel coronary disease.

The only problem of All Arterial CABG is that it is technically more demanding and the surgeon needs to be specially trained. This is why despite all the advantages only 15% of all CABGs performed all over the world are All Arterial CABGs.

CABG without blood Transfusion

There are some new advances in technology but none of them as useful as the ‘Cell Saver’ machine. The cell saver machine collects the blood lost during surgery cleans it so that it can be given back to the patient. This eliminates all the risks involved with blood transfusion –HIV, Malaria, Hepatitis etc. In patients with normal haemoglobin, CABG can be performed without blood transfusion using this machine.

CABG with No Touch Aorta technique

The possibility of avoiding the manipulation of the aorta plays a key role in the neuroprotective (protection of brain) effect of off-pump coronary revascularization, reducing the overall invasiveness. Dr Saha has devised a new surgical technique to avoid direct aorta manipulation. This eliminates the risk of stroke after CABG. Dr Saha has been invited to international conferences to share his experience in this kind of CABG.