Bypass surgery on a beating heart is an excellent option for many patients with blocked heart arteries, according to a study in Circulation: Journal of the American Heart Association.
“Our data shows that operating on a beating heart is as safe and effective as the traditional method of placing patients on a heart-lung machine during surgery,” said study author Petr Widimsky, M.D., Dr.Sc., a professor of cardiology at the University Hospital Vinohrady in Prague, Czech Republic.
The study, known as PRAGUE-4, does not prove that one method is better than the other – just that the surgeon and his or her patient now have two equally effective options, he said. “The decision of which option to choose should be made on an individual basis and depends on a number of factors, such as age, how sick the patient is, and co-existing illnesses.”
Off-pump bypass surgery is not new; in fact, surgeons have been using the technique for more than eight years, Widimsky said. “But until now, we did not have a long-term study directly comparing the newer off-pump method with classic on-pump surgery, so we did not really know which was best.”
Each year in the United States, 500,000 coronary artery bypass surgery procedures are performed after coronary arteries become clogged with fatty tissue or blood clots, Widimsky said. During the surgery, surgeons make a detour around the blocked part of a coronary artery using a blood vessel from another part of the body, usually an artery from the chest wall or vein from the leg. A key to success of the procedure has been the use of a cardiopulmonary bypass pump oxygenator – or heart-lung machine – that lets surgeons stop the heart but keep blood flowing to the rest of the body. In this setting, the surgeon is operating on a still heart.
In off-pump bypass surgery, surgeons operate on a beating heart rather than shifting the heart’s work to a mechanical pump. Since the heart is moving during the procedure, the operation is technically more demanding for the surgeon, Widimsky said.
But use of the heart-lung machine carries risks as well, he said, including an increased risk of stroke, heart attack, and in rare cases, death.
Many of the complications after bypass surgery occur when the bypass graft reclogs, he said. The goal of the new study, was to investigate how bypass grafts done on the beating heart keep their function after one year, Widimsky said. In the study, 400 patients with clogged bypass grafts were randomly assigned to on-pump or off-pump surgery.
One year later, doctors examined all the patients’ grafts using coronary angiography, an X-ray examination of the blood vessels and bypass grafts of the heart.
The study showed that both methods were equally effective, with chest arteries reclogging in only 9 percent of patients in both groups.