A Better Choice for Coronary Artery Bypass Grafts?

By Simeon Margolis, M.D., Ph.D.


Traditionally, during coronary artery bypass graft surgery (CABG) the heart is stopped and a pump outside the body continues to supply the body with blood. However, a technique devised about a decade ago (the so-called "beating heart" surgery) has made it possible for many surgeons to construct bypass grafts without stopping the heart or sending blood through the body by using a pump.

Two common side effects of CABG are an increased risk of stroke, and a post-surgical decline in cognitive function (ability to think and remember). The "beating heart" surgery—or "off-pump" method—was initially favored, in part, because it was believed to minimize or eliminate these side effects.

Hospitals are now advertising off-pump surgery, presumably to encourage patients to come to their hospital for CABG procedures. But based on the available evidence, should you choose a hospital because it offers off-pump surgery?
Although a number of studies have compared the two procedures, the findings have been mixed.

In a study presented by Dr. Danny Chu at the January 2009 meeting of the Society of Thoracic Surgeons, the mortality and stroke rates were the same when comparing large sample sizes of both procedures, although he did find that patients tended to be hospitalized longer after having off-pump procedures.

Dr. John D. Puskas, a surgeon at Emory, reached a different conclusion based on his analysis of a different database. He concluded that in both men and women off-pump surgery reduced the risk of both death in the hospital and post-operative strokes.

I tend to side with a 2005 American Heart Association scientific statement made by a committee of experts, who concluded, "Patients may achieve an excellent outcome with either type of procedure, and individuals' outcomes likely depend more on factors other than whether they underwent standard CABG or off-pump CABG." While risk of death, stroke, long-term neurological function, and even length of hospital stay appeared the same with both types of procedures, the committee did note that each procedure was associated with certain advantages.

As is usually the case, choices should not be determined by hospital advertisements. Instead, patients must make a decision after their individual circumstances are thoroughly discussed with their cardiologist and one or more cardiac surgeons.