On-pump bypass surgery better than off-pump

In bypass surgery, a healthy vein or artery called a graft is removed from leg or some other part of the body and used to bypass a blocked coronary artery. To ensure that blood is restored in the narrowed vessels, the graft is placed above and below the blocked area.

Cardiovascular surgeon and lead author of the study, Frederick Grover, MD, of the University of Colorado, Denver, said, "I would expect surgeons who are expert at performing the [off-pump] procedure and who are getting excellent results to keep doing it. But I imagine that at some institutions, fewer of them will be done."

2203 patients studied for comparative analysis
To compare the two techniques in a precise manner, researchers from the University of Colorado School of Medicine in Denver examined 2,203 patients at 18 Veterans Affairs Medical Centers who needed bypass surgery.

Through this study, the researchers sought to compare the cognitive and physical outcomes with the two procedures at 30 days and one year post-treatment.

The subjects were randomly assigned to receive either the conventional technique using a heart lung machine or the beating-heart procedure.

Of these, some patients were also given mental tests before surgery and after a year.

Study found older bypass method better
No significant differences were noted in the mortality rates or other health complications in the two groups within a month. Likewise, no mental decline was noted in either group.

However, beating heart surgeries reported the worst outcomes a year later, the researchers noted.

It was found that 10 percent of those who received the beating heart surgery had died, had another stroke or needed another surgery compared to 7 percent who received the traditional or on-pump surgery.

The researchers also noted that nearly 37 percent of the off-pump patients had at least one blocked graft compared to 29 percent of the on-pump patients.

"Our trial did not show any overall advantage to the use of the off-pump as compared with the on-pump cardiac surgical approach for coronary bypass," the researchers said. "Instead, there was a consistent trend toward better outcomes in patients undergoing conventional on-pump CABG technique."

All the patients who needed bypass surgery were males and healthier, unlike the typical bypass patients.

Researchers also stated that further research is needed to significantly prove the success of traditional method over off-pump method.

The findings of the study are published in the Nov. 5 issue of The New England Journal of Medicine.