Old-style CABG better than "off-pump"

It seemed a good idea - is a bypass while the heart still beats and spare patients the complications that can come and go on a heart-lung machine. Now, the first major test of this method produced a surprise: Bypass has fewer problems and has successfully done the old way.Most expected, there were no signs of mental deterioration in the machine for file. Avoid this problem has been considered one of the benefits of so-called "off-pump" surgery without a machine.

"For the vast majority are, there is no advantage to do so outside of the pump and there may be some inconveniences," said Dr. Frederick Grover, University of Colorado, Denver, a leading study.

CABG has been suggested that the most common operation in the world - an estimated 253.000 Americans have the operation each year. Traditionally, the operation is performed while the patient is connected to a heart-lung machine, whose task is to circulate the blood while the heart has stopped beating. The "on-pump" method makes it easier for the surgeon to create new arteries or veins attach to create detours around the clogged arteries.

But the heart-lung machine has a low risk of complications, including stroke. In the 1990s, surgeons have started doing surgery outside of the pump - without the machine, but with devices that would stabilize the beating heart.

Today, about one fifth to make deals outside of the pump, and it has been fiercely debated, which is better. Previous studies have suggested that small results were substantially the same, or gave a slight advantage to offset the pump. The debate was the attention during quadruple bypass former President Bill Clinton with a heart-lung machine in 2004. Patients are sometimes offered a choice of methods.

The research reported in Thursday's New England Journal of Medicine is the largest between the two techniques to rigorously compare. The study involved 2203 patients were enrolled in the Veterans Affairs medical centers 18.

Approximately half randomized to surgery with heart-lung machine, the side without the bypass. One month after surgery, there was no difference in the number of deaths and other complications in both groups.

But a year later, the group out of the pump had a poorer prognosis. About 10 percent had either died, had a heart attack or bypass or other procedures to open a blocked artery, cons about 7 percent of the on-pump group.

He also won the off-pump group than originally planned detours A. less of their offers were still open after a year, about 83 percent compared to 88 percent for in-line pump. Because the heart is full of blood during the off-pump surgery, it is more difficult to reach and repair the arteries behind the heart, "said Grover.

Some patients received a series of psychological tests before surgery and after one year, there was no mental deterioration in both groups.

"We still have the idea that less is more - less invasive or less nothing seems to be a better answer. This is not always the case, "said Dr. Eric Peterson, a heart doctor at Duke University Medical Center.

Peterson, who wrote an editorial in the newspaper, said he was "a particularly well done study, but not the end of the debate.

There may be certain types of patients, for whom off-pump bypass of the service, "said Grover and Peterson. Previous research has suggested that women, the elderly and people with other diseases not suck better. The VA-funded study, Peterson mostly men who were younger and healthier than the typical bypass patients found.

Based on the results, he said Grover become more conservative off-pump bypass on patients. But he agreed with surgeons, not much off pump bypass and firmly believe will probably stick with it.

"It is a good study: America must adopt? And the answer is probably not, "said Peterson