Monday, August 21, 2017

Off-Pump (Beating Heart) versus On-Pump Coronary Artery Bypass Surgery

Below is a discussion of a follow-up article published in the New England Journal of Medicine by Dr. Grover and colleagues, showing favorable results for conventional coronary artery bypass over off-pump beating heart coronary bypass surgery. The same Veterans Affairs 2009 study showed similar results at one year.

No doubt, there are select times when the beating heart approach is preferred, for example, when the aorta is calcified. Most surgeons' experience, including mine, is that the conventional coronary artery bypass approach allows for more precise sewing and better protection of the heart. This would explain why the technique of beating heart coronary bypass surgery continues to drop in the U.S. to fewer than 20% of cases. I suspect it will now be used fewer than 10% of cases.

This article may have other implications. Some surgeons tout off-pump as "better" or "safer," usually under the umbrella of "less-invasive." Understandably, patients desire safer, less-invasive procedures, with quicker recoveries. In many areas of heart surgery, techniques have been developed to yield these desired results, such as trans-catheter valve procedures and aortic stents. But for patients who require multi-vessel coronary artery bypass surgery, this long-term study suggests that the beating heart technique may not be better than the conventional approach.

The most important thing for patients is to discuss all options with their surgeons. There are surgeons who have mastered a particular technique that may yield better outcomes than reported in research studies. Many excellent surgeons continue to develop better ways to improve the safety and outcomes for our patients. Ask your surgeon for his/her experience and results, no matter the technique. Patients should also research public report cards on surgeons and seek a second opinion whenever possible.

I'm grateful to our academic leaders such as Dr. Fred Grover and I'm proud to be part of the Society of Thoracic Surgeons, for their hard to improve the health and safety of our patients.


Newer method of open-heart surgery carries more risks, study finds

The older method of doing open-heart surgery, in which the heart is stopped and a pump circulates blood through the body, leads to higher survival rates than a newer method of operating while the heart is beating, which doesn't require use of the pump, according to a new study. Why it matters: Coronary-artery bypass surgery is…


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