Overweight patients have a higher risk for complications during coronary artery bypass surgery. In off-pump bypass surgery, surgeons operate on a beating heart rather than shifting the heart's work to a mechanical pump. The off-pump technique is technically more challenging but has been associated with fewer complications.
"This study found that beating-heart surgery is even more beneficial in this group of high- risk patients," says senior author Gianni Angelini, M.D., British Heart Foundation professor of cardiac surgery at the Bristol Heart Institute, University of Bristol.
In this study, deaths among all patients – regardless of pump use – was low (1.4 percent). Yet off-pump surgery significantly reduced deaths, shortened intensive care and hospital stays, cut the need for transfusions, and reduced the risk of stroke, he says.
"The magnitude of these differences was quite striking, with the odds of some outcomes reduced more than half, and the odds of other outcomes reduced by a third to a half," he says. The use of the mechanical pump, called a cardiopulmonary bypass machine, is associated with a small, but significant, increased risk for infection, bleeding, longer hospital stays, neurological impairment and death, Angelini says. Those increased risks are true for all patients, but Angelini's team theorized that because overweight patients are already considered challenging surgical candidates, their outcome might be improved if the added risks associated with on-pump surgery were eliminated.
Angelini and colleagues studied 4,321 patients who underwent coronary artery bypass surgery from April 1996 to April 2001. They entered data from all patients into a special database that tracked medical history, surgical procedure and outcome. They identified 2,844 overweight patients. Of these, 2,261 were male and the average age was 63. Most of the patients, 76.3 percent, underwent on-pump bypass surgery.
In general, patients who had on-pump surgery were more likely to have unstable angina, have a history of heart attacks and have more extensive coronary artery disease. They were usually thinner than persons who had off-pump surgery. But patients who had off-pump surgery often had higher cholesterol or disease at the origin of the left coronary artery, Angelini says. Co-authors are R. Ascione, M.D.; B.C. Reeves, D.Phil.; and K. Rees, Ph.D. The Garfield Weston Trust and the British Heart Foundation provided a grant for the study.
CONTACT: For journal copies only,
please call: (214) 706-1396
For other information, call:
Carole Bullock: (214) 706-1279
Bridgette McNeill: (214) 706-1135