A comparison study of two heart surgery procedures that appeared in the 5th November issue of The New England Journal of Medicine reveals, coronary artery bypass surgery on a beating heart without any heart- lung machine is no more effective than traditional bypass surgery.

Approximately 1,000-patients across the country underwent beating heart or off-pump bypass surgery, while a similar number underwent on-pump surgery, after stopping their hearts, with both treatment groups having similar outcomes relating to survival and medical complications within 30-days of surgery.

Currently, one in five coronary artery bypass graft (CABG) patients in the U. S. A. under-go off-pump surgery, a number that is not expected to drop as a result of the study’s findings.

The beating-heart CABG procedure was first performed over a decade ago, becoming popular as it was widely believed to have fewer post-surgical physical and cognitive complications.

In CABG, any blockage or narrowing in a coronary artery is bypassed with a graft i. e. a piece of vein or artery, which is connected above and below the blocked area to restore the blood flow, and is referred to as revascularization. Usually, more than one blood vessel of patients in need of bypass surgery requires a graft.

There are several complications, such as, memory loss, muddled thinking, and concentration problems linked to bypass surgery and which seem to last weeks to months after surgery. While, it has not been proved, however, placement on a heart-lung machine is said to be a possible contributor to this cognitive impairment.

The current study was under-taken for comparing the cognitive and physical outcomes of the two procedures after 30-days and 1-year post-treatment.

Approximately, 2,203-patients scheduled for urgent or elective CABG, were randomly assigned to the beating heart or stopped-heart procedures. No over-all advantage was found for use of off-pump for coronary bypass, in comparison with on-pump cardiac surgical approach. According to researchers, patients under-going conventional on-pump CABG techniques showed consistently better outcomes.

All those involved in the study were men, average age 63 and with low to moderate risk, which makes it unclear whether women or older and sicker patients would benefit from the off-pump procedure.

Reviewing the research, Juan Grau, MD, a cardiac surgeon routinely performing the off-pump surgery, points out off-pump patients participating in the study, had fewer grafts than anticipated prior to surgery, which suggest their revascularization was incomplete.

It was found that patients who had grafts taken from a leg vein rather than a chest artery had poorer outcomes, as vein grafts are not considered the best choice for coronary bypass surgery.

About 20% of the 225,000 to 250,000 people under-going bypass surgery each year have it off pump.