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For Bypass Surgery, Off Is Out and On Is In

12 Nov

If you made it past my confusing post title, congratulations. This is just a short piece to acknowledge that a dear friend of mine recently underwent coronary artery bypass graft (CABG) surgery and to wish him well. He’s been in quite a lot of pain, and not resting well, so I’ve not been in direct touch with him, but according to updates from his family, he’s on the mend, which is great news. When he gets back in the groove, I’ll be curious to ask him whether his procedure was done using a heart-lung bypass machine (“on-pump”) or whether he opted for the “off-pump” procedure to avoid some of the anecdotal risks of going on the machine (e.g, stroke, cognitive deficits, and other poor outcomes).

My Papa had bypass surgery years ago and his procedure was done “on-pump.” The doctors had a difficult time getting him back off the machine and starting his heart again, and we suspect that this deprived his brain of oxygen for some period of time, because he seemed to have some cognitive issues (e.g., poor short-term memory) in the immediate wake of the event. From this experience, and stories of others like it, I can understand why people would want to opt for the “off-pump” procedure…..until you realize that that means your surgeon will be attempting to place sutures on a beating heart, which sounds a bit like sipping hot coffee on a roller coaster.

Fortunately, we now have good evidence (from a rigorous randomized control trial) that stopping the heart and using the bypass machine appears to result in better long-term outcomes than the more recently adopted “off-pump” method. The study published in the New England Journal of Medicine, finds that the patients who went on the heart-lung machine did not suffer disproportionately more adverse effects, and actually had better morbidity and mortality outcomes at one year post-operation than the group whose hearts never stopped beating throughout the surgery.

This is a great example that not all innovative practices represent progress, and that such comparative studies are necessary if we expect ongoing improvements in health care quality. I don’t know about you, but if I’m lucky to live long enough to need bypass surgery, I’m glad to be armed with this information, and only wish we had even more of it to turn to.

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Posted by on November 12, 2009 in Uncategorized

 

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