NEW YORK — It seemed like a great idea — doing bypass surgery while the heart beats, sparing patients complications from using a heart-lung machine. Now the first big test of this method has a surprise. The old way is more successful, a study has found.
There were no signs of mental decline in those on the machines. Avoiding this problem was thought be one of the benefits of "off-pump" surgery.
"For the vast majority, there's no advantage to doing it off-pump and there may be some disadvantages," said Dr. Frederick Grover of the University of Colorado Denver, one of the leaders of the study.
Traditionally, the surgery is done while the patient uses a heart-lung machine, which circulates blood. That "on-pump" method makes it easier for surgeons to attach new arteries or veins to create detours around clogged arteries.
But the heart-lung machine carries a small risk of complications, including stroke. In the 1990s, surgeons began doing off-pump surgery — without the machine but with devices that stabilize the beating heart.
Today, about one in five bypasses are done off-pump. The debate got attention when former President Bill Clinton had quadruple bypass with a heart-lung machine in 2004.
The research reported in today's New England Journal of Medicine is the largest to date to compare the two techniques in a rigorous manner. The study involved 2,203 patients at 18 Veterans Affairs medical centers.
About half were randomly assigned to bypass surgery with a heart-lung machine, half without.
A month after surgery, there was no difference in the number of deaths or other complications in the two groups.
A year later, about 10 percent of the off-pump group had died, had a heart attack or needed another bypass or procedure to open a blocked artery, compared to about 7 percent of the on-pump group.
There was no mental decline in either group.