For patients with clogged arteries requiring coronary bypass surgery, the safest option may be an operation while the heart is stopped.
Bypass surgery can be performed while the heart is still beating, but new research has revealed such surgery carries an increased likelihood that a patient will die following the procedure.
Christian Møller, a lead researcher from the Department of Cardiothoracic Surgery and The Copenhagen Trial Unit at The Copenhagen University Hospital in Denmark, said that the findings raise a red flag for performing bypass surgery on a beating heart. He said that in comparison, the traditional on-pump method appears less risky and should remain the standard surgical treatment.
During traditional bypass surgery to open narrowed arteries, the heart is stopped and a bypass or pump is used to artificially pump a patient’s blood. A newer off-pump approach uses a stabilization device so that the heart can continue beating during the operation. This method was designed to reduce complications, but Copenhagen researchers note that high quality evidence is lacking.
During the review study investigators examined 86 trials that involved 10,716 patients. They found that the overall risk of patient death was 3.1 percent for patients that received the traditional pump procedure and 3.7 percent in patients that received the procedure while their heart was still beating.
A large proportion of the trial participants were younger on average and had a lower risk of complications, and many of the trials had short follow up and a high risk of researcher bias.
However, an analysis of 10 trials with a low risk of bias and long follow up revealed a greater risk of death for patients receiving the operation while their heart was still beating. In this analysis they found that patients receiving the operation on a stopped heart had a 4.6 percent risk of dying compared to a 6.2 percent risk of death among patients who received the procedure on a beating heart.
In light of the findings the researchers recommend that beating heart surgery should be performed only in specific cases where stopping the heart could be risky. Additional trials with high quality evidence still are needed to back up the findings.
The research was recently published in journal Cochrane Library.
Coronary artery disease is the leading cause of death in the United States and in the rest of the world. Estimates point to almost one half of all middle aged men and one third of all middle aged women in the United States developing some form of CAD. The primary symptom of angina, commonly known as chest pain, occurs when the artery is almost completely blocked.
Plaques made up of cholesterol and fibrous tissue lodge in the walls of the arteries that supply blood to the heart. Slow growth of the plaques can cause chest pain as they restrict blood flow to the heart muscle, and complete closure or rupture of the plaque can cause a myocardial infarction, commonly known as a heart attack, with resulting disability or death. CAD is primarily a disease of diet and habits, with the greatest risk factors coming from smoking, high blood pressure, high cholesterol, and diabetes.