Nowadays, it is possible to perform coronary bypass grafting without stopping the heart and therefore without the need to pump the patient's blood through a heart-lung machine. Doubts about the wisdom of this 'off-pump' procedure, however, are raised by a recent study. Researchers from Royal Brompton Hospital in London, in their study included 50 patients who underwent on-pump coronary artery bypass grafting (CABG) and 54 who underwent the off-pump procedure. The surgical and anaesthetic techniques were the same in both groups, and on average, the number of grafts given to each patient was similar in both groups. In the study, more grafts closed up within three months among patients who underwent off-pump CABG than among those who underwent conventional on-pump CABG. Off-pump CABG was as safe as on-pump CABG and the off-pump surgery actually caused less heart damage than the on-pump operation. According to the team, three months after CABG 127 of 130 grafts were patent, i.e., open, in the on-pump group (98 percent) compared with 114 of 130 in the off-pump group (88 percent). Methods of treatment should not compete for patients but should be selected according to individual patients' needs in order to optimise their care. Off-pump CABG is a "valuable technique" that may benefit patients at high-risk for complications related to using a heart-lung machine, such as those with diseased aortas, lung disease, impaired liver function, or bleeding problems. However, the graft-patency rate was lower at three months in the off-pump group than in the on-pump group, and this difference has implications with respect to the long-term outcome. This finding arouses concern about the long-term outcome of this approach and further clinical trials with longer follow-up are needed.

New England Journal of Medicine,
January 2004