Beating-Heart Surgery

Beating-heart surgery is a way to perform surgery without stopping the heart. Advantages for patients include a lower risk of complications, shorter hospital stay and quicker recovery.

During beating-heart surgery, surgeons use a special device to stabilize the part of the heart on which they are operating. The heart continues to beat and circulate blood to the heart muscle during the operation. Surgery on a beating heart helps reduce the risk for complications associated with temporarily stopping the heart during surgery.

If the heart is stopped for surgery, the surgeon must restart it and reintroduce blood into the tissue. This is called reperfusion. Sometimes, heart muscle tissue can be damaged at the cellular level during reperfusion, a phenomenon known as reperfusion injury. In some people, reperfusion injury can lead to complications such as arrhythmias and heart attacks. Reperfusion injury is especially a concern in high-risk patients, including the elderly, people who have had several heart surgeries, patients with severe blockages and those with complex health problems.

What are the advantages of beating-heart surgery?

Patients who undergo beating-heart surgery can experiences:

• Better preservation of heart function
• Better survival rate, especially among high-risk patients
• Less chance for heart rhythm, kidney, or liver complications
• Quicker recovery
• Reduced hospital stay
• Reduced risk for neurological injury, including stroke and memory complications

What kinds of surgeries are performed on a beating heart?

At UChicago Medicine, our cardiac surgeons opt to perform beating-heart surgery whenever possible. More than 90 percent of coronary artery bypass surgeries performed here are done on a beating heart.

While not all procedures can be performed on a beating heart, our surgeons have developed many techniques that make beating-heart surgery an option for even complex procedures on the inside of the heart — including valve repair. In fact, our surgeons were among the first in the world to perform beating-heart mitral valve surgery. UChicago Medicine is one of the only hospitals in the nation where beating-heart surgery is being performed to treat valve disease.

Is a heart-lung bypass machine used during beating-heart surgery?

Beating-heart surgery is often described synonymous with "off-pump surgery," or surgery performed without the use of a heart-lung bypass machine. However, this is not always the case. While it is true that most beating-heart procedures (especially coronary artery bypass surgeries) are performed without the heart-lung bypass machine, surgeons do use the machine to boost circulation during select procedures or cases. Some surgeries can only be performed with the aid of the heart-lung bypass machine.

Surgery with the heart-lung bypass machine has been associated with a slight increase in the risk for complications such as stroke and memory problems. It's important to note that heart-lung bypass machines have been in use for many years, with several improvements in technology making the machines better than ever. If your surgery requires the bypass machine, be assured that our surgeons are experts is using this life-saving equipment.

Is beating-heart surgery widely available? Do most cardiac surgeons perform beating-heart procedures?

Beating-heart surgery is technically demanding, requiring specialized skills and training. Therefore, many surgeons prefer not to do surgery on a beating heart. However, since the late 1990s, beating-heart surgery has gained favor among leading surgeons around the world, especially for coronary artery bypass surgery. UChicago Medicine cardiac surgeons were among the first to see the benefits of this advanced surgical approach, and they continue to refine and develop new beating-heart procedures.