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Old bypass method has best results, study finds

Off-pump surgery was thought safer

By Stephanie Nano
Associated Press / November 5, 2009

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NEW YORK - It seemed like a great idea - doing bypass surgery while the heart is still beating, sparing patients the complications that can come from going on a heart-lung machine. Now, the first big test of this method has produced a surprise: Bypass has fewer problems and is more successful done the old way.

Most surprisingly, there were no signs of mental decline in those on the machines. Avoiding this problem was thought to be one of the benefits of “off-pump’’ surgery without a machine.

Traditionally, the surgery is done while the patient is hooked to a heart-lung machine that circulates blood while the heart is stopped. That method makes it easier for surgeons to attach new arteries or veins to create detours around clogged arteries.

But the machine carries a small risk of complications, including stroke. In the 1990s, surgeons began doing off-pump surgery. Today, about 1 in 5 bypasses are done off-pump, and it’s been debated which is better. Small studies have suggested outcomes were about the same, or gave a slight advantage to off-pump.

The research reported in today’s New England Journal of Medicine is the largest to date to compare the two techniques in a rigorous manner. The study involved 2,203 patients at 18 Veterans Affairs medical centers.

About half were randomly assigned to surgery with a machine, half without. A month later, there was no difference in the number of deaths or complications in the groups.

But a year later, the off-pump group had worse outcomes. About 10 percent had either died, had a heart attack, or needed another bypass or procedure, compared with about 7 percent of the on-pump group.