Issues arise with ‘Off-Pump’ Coronary Bypass

These days, it’s possible to perform coronary bypass grafting without the need to stop the heart and therefore without the need to pump the patient’s blood through a heart-lung machine. Doubts about the wisdom of this ‘off-pump’ procedure, however, have been raised by a study released this week.

These days, it’s possible to perform coronary bypass grafting without the need to stop the heart and therefore without the need to pump the patient’s blood through a heart-lung machine. Doubts about the wisdom of this ‘off-pump’ procedure, however, have been raised by a study released this week.In the study, more grafts closed up within three months among patients who underwent off-pump coronary artery bypass grafting (CABG) than among those who underwent conventional on-pump CABG.This finding “arouses concern about the long-term outcome of this approach, and further clinical trials with longer follow-up are needed,” Dr. Natasha E. Khan from Royal Brompton Hospital in London and colleagues write in their article in this week’s New England Journal of Medicine (news – web sites).In the study, 50 patients underwent on-pump CABG and 54 underwent the off-pump procedure. The surgical and anesthetic techniques were the same in both groups, and on average the number of grafts given to each patient was similar in both groups.Off-pump CABG was as safe as on-pump CABG, and the off-pump surgery actually caused less heart damage than the on-pump operation.According Khan’s team, three months after CABG 127 of 130 grafts were patent, i.e., open, in the on-pump group (98 percent) compared with 114 of 130 in the off-pump group (88 percent).”Radial-artery grafts appear to be the most vulnerable conduit in the off-pump group,” the investigators found.Writing in an editorial, two cardiac surgeons from Boston emphasize that off-pump CABG is not for everyone. “Methods of treatment should not compete for patients but should be selected according to individual patients’ needs in order to optimize their care,” Drs. Thomas E. MacGillivray and Gus J. Vlahakes from Massachusetts General Hospital write.Off-pump CABG is a “valuable technique” that may benefit patients at high-risk for complications related to using a heart-lung machine, such as those with diseased aortas, lung disease, impaired liver function, or bleeding problems, they add(Source: New England Journal of Medicine, Reuter’s Health, Jan 2004.