Pumps are better for heart bypass surgery

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Sometimes the old ways are better.

Historically, surgeons performing coronary artery bypass graft, commonly known as CABG (pronounced cabbage), for blocked arteries would stop the heart, using a heart-lung bypass machine to keep the patient alive during the procedure. In recent years, however, who’s known as the beating-heart procedure, in which the heart is allowed to continue working, has become more popular. Cardiologists assumed that using the heart-lung machine increased the risk of stroke and of mental impairment after the surgery. Turns out that, in most cases, those concerns were misplaced and the machine is better.

CABG, in which a healthy vein is removed from a leg or elsewhere and used to bypass a blocked coronary artery, is the most common surgical procedure in the world. An estimated 253,000 Americans undergo the procedure each year at a cost upwards of $30,000 -- although beating-heart surgery is generally about 25% cheaper, another argument in its favor. (Another 1 million or more undergo balloon angioplasty in which a catheter is inserted through a vein in the groin and an inflatable balloon is used to compress the blockage, allowing blood to flow again.)

A team led by Dr. Frederick Grover of the University of Colorado School of Medicine in Denver studied 2,203 patients at 18 Veterans Affairs Medical Centers who needed bypass surgery. They were randomly selected to receive either the conventional technique or the beating-heart procedure.

The team reported today in the New England Journal of Medicine that initial results of the two procedures were comparable. At one month, no differences were observed in deaths or other complications following the surgery. But a year later, the story was different. About 2.7% of those receiving beating-heart surgery had died, compared with only 1.3% of those hooked up to the heart-lung machine. Overall, when deaths, strokes, heart attacks or the need for another bypass were included, problems were observed in 10% of those who received beating-surgery surgery compared to 7% of those on the machine. Some of the patients were given mental acuity tests before and after the procedures, and no differences were observed between the two types of surgery.

There were limitations to the study. All of the patients were male and younger and healthier overall than typical bypass patients. Some studies have suggested that the beating-heart procedure is better for women, the elderly and those with other illnesses. That possibility will have to be addressed in other studies.

Grover said he suspects many surgeons who prefer the beating-heart procedure will keep right on doing it. But for himself, he said he would be more conservative in deciding which patients should receive it.

-- Thomas H. Maugh II