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Heart Disease In The News Off-pump surgery in high-risk bypass patients A relatively new surgical technique, in which coronary artery bypass grafting is accomplished without using the heart-lung bypass pump, avoids many of the post-operative problems attributed to the bypass pump. This surgical technique is technically more difficult than standard bypass surgery, and special requires training and experience. For this reason, its use has largely been limited to "ideal" patients - those who have no special risks for bypass surgery. A review in the Annals of Thoracic Surgery takes another look at the conventional wisdom that off-pump bypass surgery should be avoided in high-risk patients. The authors conclude the opposite - from the limited data available so far, if the bypass pump can be avoided, high-risk patients actually seem to have better outcomes than they do with standard bypass surgery. By high-risk patients, the authors are referring to patients having repeat bypass surgery, advanced age (over 80), or significant left ventricular dysfunction (ejection fraction less than 35%). The authors call for randomized trials to be set up to systematically examine the effect of performing off-pump bypass surgery in these high-risk patients. |
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