Conventional methods
During the last 40 years which have been employed to change the arteries of the heart have consisted of stopping it during a period that could be up to the three hours, and during that period of inactivity new arteries are sewed to the zones of the coronary arteries that did not receive blood. This procedure is secure and counts on a lot of experience on a worldwide basis. The key of its success consisted of the technological advance that permitted to develop capable machines to substitute the heart and the lungs during a short period of time, permitting to maintain the heart and the lungs stopped in order for the surgeon to repair them. A heart stopped can be rotated and moved to positions in which it would be impossible if it was in motion, and by being motionless it is possible to carry out the microsuturas of precision that require a revascularization intervention.
Nevertheless, in spite of the efficacy of the method, in some patients it can produce problems due to the pass of the blood by exterior artificial surfaces to the body, and from time to time cerebral damages by the need that exists by this method to manipulate the aorta and to introduce tubing’s in it. This manipulation enlarges the risk that alterations can occur in the conduits that carry the blood to the brain.
The surgery without stopping the heart
Is being used for over 10 years in various centres on a worldwide basis , it combines what has been learned in these 40 years of coronary revascularization with the new technological devices that permit to sew arteries of the heart while this continues functioning. This modality of surgery is called OPCAB ("off-pump coronary artery bypass"), in Spanish "Cirgugia coronaria sin bomba".
In the surgery without bomb the heart is not stopped. It is not necessary to employ the machine heart-lung, that is the artificial bomb that maintains the patients with life in the surgery using the traditional method. As it is not necessary to stop the circulation, it is neither necessary to carry out the steps of the surgery with bomb that suppose a risk for the patient, as to manipulate the aorta or to introduce tubing’s in he/her, neither to have the blood crossing artificial surfaces. 
The employed devices in the surgery "without bomb" paralyze only the small part of the heart on the area that is going to worked on. The immobility of this zone is compensated by the anaesthetist by means of medicines and actions that permit that the zones of the heart that are not paralyzed assume the functions of the parts whose contraction is reduced to sew the vessels. In the habitual interventions it is necessary to repair various vessels in several zones of the heart. To the extent that when a vessel is repaired, the devices are removed of that zone permitting that to be contracted again, and they are moved onto the following zone to be repaired by immobilizing it. By this technique, a large territory is never maintained immobilized , what permits the heart to be capable to function in spite of it being repaired.
In the first interventions of this type were carried out on the arteries of the previous part of the heart, that remained in front to the surgeon when the thorax was opened. Nevertheless, the arteries of the subsequent and lower part of the heart cannot be repaired easily without changing the position of the heart of its habitual place. Again, the technology has surpassed this problem. In the same way there are devices to immobilize, it exists others that displace the heart of their normal position, and they rotate it, but in such a way that its cavities remain intact and they can continue functioning. At present it is virtually possible "to remove" partly the heart almost to the exterior, out of the thorax, and for it to continue functioning correctly.
New methods have required an intense training of the surgeons that apply them, and the change of the mentality of work of all the surgical teams, surgeons and nurses, as of the anaesthetists to the doctors of intensive cares which receive the patients after the surgery.
Advantages for the patient
Besides the advantages of smaller blood and cerebral damage, is the fact that the circulation stops at no time what permits a habitually faster recovery of the patient owed to the change of the dynamics of work. In ours centres, it is habitual that almost all the patients leave awake of the intervention and that their stay in the UVI is not prolonged more than 18 hours. On the other hand, with the traditional methods it was habitual to awake the patient several hours after the intervention.
Not all the patients bear the prolonged immobilization of a part of their heart, or its illness has special characteristics that do not make viable the interventions "without bomb". In these cases, when the surgeon observes during the intervention that the patient is not tolerating well the surgery, is carried out what we call "conversion" : they withdraw the devices that maintain immobilized the heart, and the intervention is carried out the traditional way, this is, connecting the machine heart-lung (the bomb). All in all, is a matter of offering the patient the best possible option in each case.
Woman of 58 years of age who presents frontal migraine of oppressive type, followed by sensation of sicknesses and loss of consciousness.
Man of 49 years of age who begins a month ago with symptoms of intermittent yielding to the few meters. After physical exam emphasizes the absence of poplíteo pulse and distant in right lower member. 
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