A more modern technique for performing coronary bypass surgery is associated with worst patient outcomes than the original method, according to a study published in The New England Journal of Medicine.
Traditionally, surgeons stoped the heart and used a cardiopulmonary bypass pump to circulate blood throughout the body during the procedure. The newer technique allows allows the heart to remain beating during the procedure and doesn't require the use of the pump. The off-pump method was developed in the 1990s to address concerns that use of pumps could increase the risks of stroke or other neurocognitive issues.
For the study, researchers randomly assigned on-pump or off-pump coronary bypass surgery to more than 2,000 patients treated at 18 medical centers from February 2002 through June 2007. All participants were male and U.S. military veterans. The team tracked the patients for five years after the surgery and found 11.9 percent of the on-pump patients died, while the death rate for the off-pump patients was 15.2 percent. On-pump patients were also less likely to experience adverse cardiovascular events or have a repeat procedure to open or bypass a coronary artery.
"The takeaway is that the off-pump should be used with caution, unless you have a … very high-risk patient [like someone with impaired organ function] who you think would benefit from not having to be on a heart-lung machine," Frederick Grover, MD, a cardiothoracic surgeon at the University of Colorado School of Medicine in Aurora, told STAT.
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