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OFF-PUMP HEART SURGERY REDUCES COMPLICATIONS IN OVERWEIGHT PATIENTS
The findings of the study, which was funded by the British Heart Foundation and Garfield Weston Trust, are significant as overweight patients are known to be at greater risk of complications during the traditional procedure than other patients. In off-pump bypass surgery, surgeons operate on a beating heart, rather than stopping the heart and diverting the blood-flow through a mechanical heart and lung bypass machine (cardiopulmonary bypass machine). Use of the bypass machine is associated with a small, but significant, increased risk of infection, bleeding, longer hospital stays, neurological complications and death. The off-pump technique, although technically more challenging, has been associated with fewer complications. In the study, deaths among all patients, regardless of pump use, was low (1.4 percent). Yet off-pump surgery significantly reduced deaths, shortened intensive care and hospital stays, cut the need for transfusions and reduced the risk of stroke. Author of the study Professor Gianni Angelini, BHF Professor of Cardiac Surgery at the Bristol Heart Institute, University of Bristol, said: "The study found that off-pump beating heart surgery is even more beneficial for this group of high-risk patients." He continued: "This was in line with our theory that because overweight patients are considered to be more challenging surgical candidates, the outcome of operations might be improved if the added risks associated with on-pump surgery were eliminated. The results were quite striking, with the odds of some complications reduced more than half, and the odds of others reduced by a third to a half." Professor Sir Charles George, Medical Director at the BHF, said: "With rising levels of obesity an increasing number of overweight people will need to have heart bypass operations. Any procedure that improves patient safety, particularly for higher risk groups, should be encouraged." Over 28,000 coronary artery bypass grafts are currently carried out each year in the UK. At Bristol Royal Infirmary the off-pump technique, which is also estimated to cut the cost of the procedure by 30%, is being used in 60% of cases. Professor Angelini and his team studied 4,321 patients who underwent coronary artery bypass surgery from April 1996 to April 2001. They entered data from all patients into a special database that tracked medical history, surgical procedure and outcome. They identified 2,844 overweight patients. Of these, 2,261 were male and the average age was 63. The British Heart Foundation is a major national charity that plays a leading role in the fight against heart and circulatory disease, the UK's biggest killer. It is the largest independent funder of heart research in this country. The Foundation also plays an important role in funding education, both of the public and of health professionals, and in providing life-saving cardiac equipment and support for rehabilitation and patient care. The paper (NR02-1148 Circ/Angelini) is published in the rapid access issue of Circulation: Journal of the American Heart on September 16. Co-authors are R. Ascione, M.D.; B.C. Reeves, D.Phil.; and K. Rees, Ph.D. The Garfield Weston Trust and the British Heart Foundation provided a grant for the study. A coronary artery bypass graft is often needed when an artery in the heart is narrowed or blocked due to coronary heart disease. During the procedure, an artery of vein from another part of the body is grafted to the heart to 'bypass' the narrowed area.
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