Coronary Artery Disease (CAD) is one of the leading causes of death among Thai people. According to data from the Ministry of Public Health, over 400,000 Thais are currently living with this condition, and many more remain at risk without being aware of it. If left untreated, CAD can lead to serious complications such as acute myocardial infarction (heart attack) or heart failure.
What is Coronary Artery Disease?
Coronary Artery Disease (CAD) is a condition in which the coronary arteries—responsible for supplying blood to the heart muscle—become narrowed or blocked. The primary cause is the buildup of fatty deposits or cholesterol within the arterial walls, forming plaques. This buildup leads to hardening and narrowing of the arteries, reducing blood flow to the heart. When the heart muscle receives insufficient blood supply, it can cause chest pain or discomfort, particularly during physical exertion such as brisk walking, climbing stairs, or periods of emotional stress. In some cases, symptoms may even occur at rest.
Key risk factors for CAD include advancing age, genetic predisposition, being overweight, and having chronic conditions such as diabetes, high blood cholesterol, or high blood pressure. Lifestyle habits also play a role—such as smoking, consuming a high-fat diet, and lack of regular physical activity.
Understanding Off-Pump Coronary Artery Bypass Surgery (OPCAB)
Off-Pump Coronary Artery Bypass (OPCAB) is a surgical technique used to treat coronary artery disease, in which the coronary arteries become narrowed or blocked. Unlike traditional bypass surgery, OPCAB is performed while the patient’s heart continues to beat naturally. The heart is not stopped, and a cardiopulmonary bypass machine (heart-lung machine) is not used during the procedure.
Steps of Off-Pump Coronary Artery Bypass Surgery (OPCAB)
- Diagnosis
The physician will begin with a thorough medical history and physical examination, followed by diagnostic tests such as an electrocardiogram (EKG), an exercise stress test, or an echocardiogram to assess heart function. If coronary artery disease is suspected, a coronary angiogram may be recommended to evaluate the location and severity of the blockage.
- Preoperative Preparation
A comprehensive health assessment will be conducted, including chest X-rays and evaluations of the function of vital organs such as the kidneys, lungs, and liver to assess surgical risks—particularly in elderly patients or those with multiple comorbidities. In some cases, a CT scan may be needed to evaluate the presence of calcification in the coronary arteries.
- Surgical Procedure
The surgeon will make an incision through the sternum (sternotomy) to directly access the heart. Healthy blood vessels—such as the internal thoracic artery, radial artery (from the arm), gastroepiploic artery (from the abdomen), or saphenous vein (from the leg)—will be harvested and used to create bypass grafts. These grafts are connected to the coronary arteries beyond the blocked segments, allowing blood to flow through a new path to supply the heart muscle.
During the surgery, the surgeon uses a local stabilizer to immobilize a specific area of the heart’s surface, providing a still and stable field for precise suturing of the new grafts. Meanwhile, the rest of the heart continues to beat and pump blood normally.
The OPCAB technique requires a high level of expertise from cardiac surgeons, as operating on a beating heart involves added complexity—such as maintaining stable blood flow and blood pressure, stabilizing the heart, and continuously monitoring cardiac function throughout the procedure.
- Postoperative Recovery
After surgery, the patient will stay in the intensive care unit (ICU) for close monitoring of possible complications such as arrhythmias or bleeding. Once stabilized, the patient will be transferred to a regular ward. The total hospital stay typically ranges from 3 to 7 days, depending on the patient’s condition and any complications that may arise.
- Long-Term Care
Patients will need to take medications to prevent recurrent narrowing of the arteries and manage underlying risk factors such as diabetes, hypertension, and high cholesterol. Regular physical activity and participation in a cardiac rehabilitation program are also recommended to strengthen heart function and reduce the risk of future blockages, following the guidance of the healthcare team.
Advantages of OPCAB Compared to Conventional On-Pump Coronary Artery Bypass Surgery
- Reduced risk of complications related to the use of the cardiopulmonary bypass machine, such as excessive bleeding, cardiac arrhythmias, postoperative cognitive dysfunction (POCD), and acute kidney injury—especially common in elderly patients.
- Lower need for blood transfusions or blood components during and after surgery.
- Significantly reduced risk of stroke or paralysis when compared to traditional on-pump bypass surgery.
- Less inflammation: The cardiopulmonary bypass machine can trigger immune system activation, potentially leading to inflammation of various organs. OPCAB helps minimize this response.
- Faster recovery: Patients typically require a shorter stay in the ICU and a shorter overall hospitalization period, enabling a quicker return to daily life.
Who Is a Good Candidate for Off-Pump Coronary Artery Bypass Surgery (OPCAB)?
- Patients with multiple blocked coronary arteries or total occlusion, especially in locations that are unsuitable for balloon angioplasty or percutaneous coronary intervention (PCI).
- High-risk patients, including the elderly, those with kidney or lung disease, or multiple chronic conditions. OPCAB is also suitable for patients with poor heart contraction function, who may face increased risks from cardiopulmonary bypass.
- Patients with heavy calcification in the ascending aorta (aortic calcification), where using a heart-lung machine during traditional bypass surgery may increase the risk of stroke or paralysis.
- In general, most patients with coronary artery disease can be considered for OPCAB, depending on an individual assessment by the cardiac surgeon.
Treating Coronary Artery Disease by a Team of Specialists and Multidisciplinary Professionals
Off-Pump Coronary Artery Bypass (OPCAB) is a valuable treatment option, especially for high-risk patients. However, selecting the most appropriate surgical approach should be done in consultation with a cardiologist and a multidisciplinary medical team to ensure a comprehensive evaluation and tailored treatment plan.
At the Heart Center, Phyathai 2 Hospital, we offer comprehensive care for patients with coronary artery disease. Our experienced team of cardiothoracic surgeons and cardiologists utilizes advanced OPCAB techniques to minimize the risk of postoperative complications. Patients receive attentive care from a multidisciplinary team—including nurses, physical therapists, dietitians, and rehabilitation specialists—throughout every stage of their journey, from diagnosis and treatment to recovery, to help them regain confidence and enjoy a better quality of life.
Additionally, patients can choose personalized care packages to suit their needs, including premium hospital rooms, customized meals, or dedicated nursing services. This reflects our Value Healthcare approach—combining high-quality medical care with cost-effective solutions. Treatment plans can be tailored to align with each patient’s budget while maintaining international safety and care standards, ensuring you receive the best possible care at every step of your treatment.
