Title : Beating-Heart Surgery
link : Beating-Heart Surgery
Beating-Heart Surgery
The latest innovation in Coronary Artery Bypass Graft (CABG) surgery is a procedure called off pump bypass or beating-heart surgery. In this procedure, the operating team doesn’t stop the heart and place the patient on a heart-lung machine. Instead, the surgeon uses special equipment to hold the heart steady, enabling the surgeon to operate on it while it continues beating. The surgeon still splits the entire breastbone but avoids putting the patient on the heart-lung machine. Off-pump CABG is probably best suited for patients in whom the heart-lung machine may pose important complications
such as neurological deficits or kidney failure.
By avoiding the heart-lung machine, off-pump CABG was also expected to lower the rate of some complications, such as memory impairment and lessened ability to concentrate. But a 2002 study in the Journal of the American Medical Association found that after twelve months, patients who had the off-pump procedure were as likely to have suffered memory loss and other cognitive problems as patients who had conventional bypass surgery. However, with just 281 patients, the study was too small to be definitive.
Another key question is whether the beating-heart procedure is as effective as standard coronary artery bypass graft surgery. Results from a recent study at one hospital that regularly performs this operation were encouraging. Investigators found that outcomes were very good and that they improved over time as the doctors became more experienced. By the last 174 cases in the series, one-year survival rates were excellent. But it’s too early to tell whether survival rates were as good as those of patients who had conventional bypass surgery. Another paper published in the New England Journal of Medicine, however, suggested that the patency of CABG grafts in off-pump surgery were inferior to conventional on-pump surgery. Many surgeons currently believe that off-pump surgery should be used in selected patients to decrease the risk associated with the heart-lung machine, but
should not be the first choice for most patients.
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