Beating-Heart Surgery Found Best for the Elderly

For patients over 80, bypass surgery on a beating heart may be the best option, since it leads to fewer strokes and higher 30-day survival rates, according to a study in the September 17, 2002, issue of Circulation.

During bypass surgery, surgeons either use a pump oxygenator, also known as a heart-lung machine, that lets them stop the heart during the operation or they operate on a beating heart. Patients over 80 are at high risk for complications after bypass surgery, so some doctors have suggested that the off-pump surgery might be better for them. Researchers tested the theory be reviewing bypass surgery records. Between 1995 and 1999, 125 patients over 90 had bypass surgery, 63 on-pump and 62 off-pump. The preoperative health characteristics of the two groups were very closely matched

The operative mortality—death occurring within 30 days of surgery—was 15.9% in the on-pump group but only 4.8% in the off-pump group. Moreover, four postoperative strokes occurred in the on-pump group and none in the off-pump group. A prospective randomized study is under way to confirm the findings.

"Even though the design of this study isn't perfect,” said Louis P. Perrault, M.D., Ph.D., a cardiovascular and thoracic surgeon at the Montreal Heart Institute (MHI, Quebec, Canada), "the results are hard to ignore. If some centers are not believers in off-pump surgery, these findings should encourage them to rethink their position in the over-80 group.”




Related Links:
Montreal Heart Institute