CABG surgery on the beating heart (off-pump surgery) is increasingly being used when restoring coronary artery blood flow as an alternative to conventional heart bypass (where a mechanical pump is used to maintain blood flow after the heart has been stopped [on-pump surgery]). Gianni Angelini and colleagues from the Bristol Heart Institute, UK, analysed pooled data from two randomised trials which compared the short-term and mid-term outcome associated with off-pump and on-pump surgery.
Off-pump surgery substantially reduced in-hospital complications compared with on-pump surgery. Atrial fibrillation (irregular fast heartbeat) was reduced by 25%, chest infection by 12%, the need for red-blood-cell transfusion by 33%, and extended hospital stay (more than one week) by 13%.
Mid-term mortality data (gathered from 1-3 years follow-up) were similar between the two groups. 2% of patients in the off-pump group died from any cause, compared with 3% in the on-pump group. 17% of patients in the off-pump group died or had a cardiac-related event compared with 21% in the on-pump group.
Gianni Angelini comments: “CABG surgery on the beating heart is gaining popularity, however until now there has been a lack of evidence that it improves outcome. In Bristol we already use this new technique in 60% of cases. We hope that our evidence will encourage more surgeons to use this new technique which we have shown can reduce complications and save hospital resources.” (Quote by e-mail; does not appear in published paper).
Contact: Professor Gianni D Angelini, Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol BRISTOL, BS2 8HW,UK;T) +44 (0) 117 928 3145;F) +44 (0) 117 929 9737; E) G.D.Angelini@bristol.ac.uk
The Lancet