'Beating Heart' Bypass Surgery May Be Riskier

It's been about six weeks since Frank Aylor had open heart surgery, and he's already up and jogging again.

"I'm not the type that likes to sit at home, I like to be at work," Aylor said.

Fortunately for Aylor, only one month after his heart bypass surgery at Vanderbilt University Medical Center in Nashville, Tenn., he was able to return to work.

"I'm amazed, people at work are amazed, they can't believe that I had open heart surgery a month ago," he said.

Vanderbilt's approach to this type of surgery is not the typical one. While about 80 percent of bypass surgeries done nationwide are performed with the patient on a heart and lung machine -- an approach called an "on-pump" bypass -- 95 percent of the bypass surgeries done at Vanderbilt use a newer, and often controversial, technology that allows the surgery to be done "off-pump."

During off-pump, or "beating heart" surgery, a surgeon uses a device to stabilize the heart so it does not move as much as it beats. The heart continues beating on its own throughout the procedure -- a situation that makes the surgery more technically difficult. However, some reports in the past have suggested that the off-pump technique could lead to a lower risk of certain negative effects on cognitive function after on-pump surgery.

But on Wednesday, a new study of more than 2,200 bypass surgery patients suggested that off-pump surgery may not be the best choice in many cases. The study, published in the Nov. 5 issue of the New England Journal of Medicine, found that bypass surgery patients have a lower risk of heart attack or stroke if the surgeons opt for on-pump instead of off-pump bypass procedures.

And perhaps the biggest surprise: the study found that the on-pump group was no more likely to have thinking or memory problems than those who had beating heart surgery, said Dr. Eric David Peterson of Duke University Medical Center in Durham, N.C., in an accompanying editorial.

Still, the study is unlikely to end the debate over use of the heart-lung machine in bypass surgery, because many doctors, even those who are skeptical of the off-pump procedure, still feel it has its place in the realm of bypass surgeries.

Dr. Patrick McCarthy, chief of Cardiothoracic Surgery at Northwestern Memorial Hospital in Chicago -- where over 90 percent of bypass surgeries are done on-pump -- commented that, "off-pump has not achieved the promises of a decade ago [but] I would ... hasten to add that it is still a useful technique in a subset of patients."

"I think that the findings of the study are applicable to the vast majority of patients requiring [this] surgery," said Dr. Aubrey Galloway, chairman of the Department of Cardiothoracic Surgery at New York University, "[but] certain caveats do exist, however. The study excluded certain high risk groups, and off-pump remains a valuable technique that may lower the risk of stroke in select elderly patients with advanced [heart] disease."

On the other hand, Dr.Clyde Yancy, president of the American Heart Association, concluded that "based on these results, any patient who is a reasonable candidate for on-pump bypass -- even if the option for off-pump exists -- should undergo on-pump surgery."

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