Poorer Outcomes After 'Off-Pump' Bypass Surgery

Nov. 5 -- WEDNESDAY, Nov. 4 (HealthDay News) -- Longer-term outcomes for people who had coronary bypass surgery "off-pump," meaning without the use of a heart-lung machine, were worse than for those undergoing the conventional procedure, a major study finds.

One year after surgery, about one in 10 patients getting the off-pump procedure had died, suffered major complications, had heart attacks or required repeat bypasses, compared to 7.4 percent of those who underwent operations using heart-lung machines, researchers report in the Nov. 5 issue of the New England Journal of Medicine.

And the hoped-for advantage of off-pump bypass in other areas, such as less effect on mental function, did not show up, said study co-author Dr. Frederick L. Grover, chair of surgery at the University of Colorado, Denver.

"We thought they would end up doing better neurologically, or that other organs would do better, or they would get out of the hospital faster -- and that did not pan out," Grover said.

Follow-up scans also showed that fewer of the off-pump grafts remained open after a year (82.6 percent vs. 87.8 percent). The percentage of grafted blood vessels that became narrower and less able to supply the heart with blood was also higher in the off-pump group, the researchers reported.

The study included more than 2,200 adults, almost all of them men, who had bypass surgeries at 18 Veterans Administration medical centers across the country. The research was needed because initial enthusiasm for the off-pump procedure has since been "tempered by concern" about the long-term effectiveness of the operation, the report's authors explained.

About 20 percent of bypass operations in the United States are done off-pump, Grover estimated.

There still is a role for off-pump bypass surgery, he said, based on individual surgeon's expertise and patient characteristics, but the study indicates that the procedure's role will be limited.