Beating-Heart Bypass Bests On-Pump Surgery

A new study has shown that beating-heart bypass surgery has a number of benefits over surgery conducted with the use of a heart-lung machine. The results were reported in the April 21, 2004, issue of the Journal of the American Medical Association (JAMA).

The prospective, randomized blinded study, known as the SMART (surgical management of arterial revascularization) trial, involved 197 patients. About half of these patients had beating-heart surgery, while the rest were on a heart-lung machine. The results showed that those who had beating-heart surgery spent less time on a ventilator, had less damage and trauma to the heart, had a shorter hospital stay, required fewer blood transfusions, and had lower surgical costs. There were no differences among the two groups in the incidence of death, heart attack, stroke, recurrent angina, hospital readmissions, or percutaneous intervention.

"Publication of these results has given additional visibility and credibility to our findings that beating-heart patients do just as well--and in fact recover sooner with shorter ICU [intensive care unit] and hospital stays--than those put on heart-lung machines for bypass,” noted Dr. John Puskas, of Emory Crawford Long Hospital at Emory University in Atlanta (GA, USA), who performed the procedures. "This is important information for physicians, who until now haven't had good prospective data comparing revascularization and other efficacy measures.”

Restoration of blood flow to the heart was demonstrated in angiograms prior to discharge from the hospital, and graft durability and patency was confirmed in angiograms one year later. As of January 2004, none of the patients had required surgical reintervention.




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