About half a million Americans undergo coronary bypass surgery annually. After having this procedure, it's not unusual for heart patients to say they're lucky to be alive.
James “JC” Cunningham is one of those people. As the Lake Forest resident waited for his wife outside a local mall, he felt a sudden, knife-like pain between his shoulder blades. Sensing something was terribly wrong, he entered the shopping center to search for his wife. Although the pain subsided by the time he found her, the couple decided to check JC’s blood pressure at a do-it-yourself monitor in the mall pharmacy. It was alarmingly high. “We were both scared,” says JC. “I told my wife to get me to the hospital.”
Luckily, the Cunninghams were only a short distance from Saddleback Memorial's emergency department. Within minutes of JC’s arrival, the hospital’s ER team assessed his condition. As soon as they confirmed his blood pressure reading, “they put me in intensive care – very fast,” he says. It didn’t take long for cardiothoracic surgeon David Perkowski, M.D., to diagnose JC’s problem. “Testing confirmed that he’d had a heart attack,” says Dr. Perkowski. “Three of his coronary arteries were almost 100 percent blocked. Angioplasty, a minimally invasive procedure used to open narrowed or blocked vessels, wasn’t appropriate in JC’s case. He needed bypass surgery.”
After being stabilized over the next three days, the oil and gas consultant underwent coronary bypass surgery. But instead of the traditional method in which the patient’s heart is stopped and a machine is used to take over the function of the heart and lungs, JC had a leading-edge procedure called “off-pump” or “beating heart” bypass surgery. Because this approach doesn’t employ a heart-lung machine, problems sometimes associated with traditional bypass surgery are reduced or eliminated.
“Although the heart-lung machine has been the medical standard for more than 25 years, it poses risks, including stroke, kidney failure and other complications,” explains Dr. Perkowski, who has performed nearly 1,500 off-pump procedures since 1997.
During beating heart surgery, doctors use sophisticated equipment to lift the heart from the chest cavity and stabilize the organ—reducing its movement, but not stopping it completely. Since the heart continues to beat throughout surgery, there’s no need for a heart-lung machine. “Typically, off-pump patients are more comfortable after surgery, spend less time in the hospital and return to normal activities faster than patients who have the conventional bypass procedure,“ comments Dr. Perkowski.
True to form, JC’s recovery went smoothly. Three days after surgery, he was released from the hospital and began cardiac rehab. “I could feel myself come back to life,” he says, noting that he had no permanent damage from the heart attack. “I was so lucky that off-pump bypass surgery was available to me. It shortened my recovery time and made a difference in my comfort level.”
Within two weeks of his operation, JC was back at work full time. “My breathing was so much better than it had been before my operation and I had plenty of energy,” he says. “I was blessed to be put in the hands of a wonderful doctor with such a unique approach to bypass surgery.”
Off-Pump Bypass Surgery
Every year, almost 500,000 patients receive the news that they need bypass surgery. Most undergo an operation in which traditional methods are used, including the use of a heart-lung machine to temporarily stop the heart and reroute circulation while doctors repair blocked arteries.
A growing number of patients, however, are now being given the option of off-pump bypass surgery (OPBS)—a method pioneered by David Perkowski, M.D., a Saddleback Memorial cardiac surgeon. Unlike traditional bypass surgery, OPBS involves operating on a beating heart, eliminating the need for a heart-lung machine. As a result, problems sometimes associated with traditional bypass surgery are reduced or eliminated. Among them are renal failure, postoperative stroke and memory loss. OPBS patients also experience a reduction in wound infection and blood loss. “Typically, off-pump patients leave the hospital sooner and return to normal activities faster than patients who have conventional bypass surgery,” says Dr. Perkowski.