Older Method of Coronary Bypass with Heart Lung Machine Best, Off-pump has Worse Outcomes

[steven johnson]

I had a choice between off-pump coronary bypass surgery and that using a heart-lung machine. I looked up the results out at the time. The off pump bypass coronary grafts had three times the failure rate of those done on the heart lung machine.

I've had a perfect outcome. Of course, it also gives me an excuse for memory lapses and typographical errors -- it's my cognitive dysfunction.

In the study, published Thursday in the New England Journal of Medicine, 2,203 patients were randomly assigned to have their bypass surgery on pump or off. Because the study was sponsored by the Department of Veterans Affairs, the patients were mostly men.

A year later, those who had had off-pump surgery had poorer outcomes. Fewer bypasses stayed open and patients were more likely to have needed a repeat operation or to have had a heart attack or to have died. They were no less likely to have had strokes or difficulty thinking.

Some surgeons who made off-pump surgery their specialty said they were not going to change. The results do not apply to them, they say, because they have extraordinary expertise.



Older Bypass Method Is Best, a Study Shows

[Arctic Dave]

1. I will tuck this in the back of my mind just in case it ever becomes necessary.

[hedgehog]

2. Whatever happened to the reports that donated blood didn't have enough

dissolved nitrogen gas, and that this is what caused the problems following by-pass surgery?

[Warpy]

3. Few patients I took care of out of hundreds

over the years needed blood postop. Anemia after surgery was generally corrected with iron supplement and transfusion was only ordered if the anemia became severe.

Transfusion is still seen as relatively high risk, more so than mild post operative anemia.

However, yes, they've found that the loss of nitrogen oxide greatly affects the oxygen carrying capacity of transfused blood. I don't know what they've done about that, if anything. The information came out in 2007 and it takes a while for corrective measures to be developed.

The difference in outcomes between on and off pump surgeries likely has more to do with a smaller window for the off pump surgery leading to a rushed surgical team, although they'd be the last to admit it, and quite possibly with increased stress on the patient.

The holy grail for heart bypass surgery is a minimally invasive operation that doesn't involve a saw or rib spreader along with the bypass machine. We're just not there yet, as this study confirms.