Grover’s team also looked for other outcomes after five years, including death from heart disease and the rate of nonfatal heart attacks. The rates of these secondary outcomes appeared to be about the same for both groups, the researchers found.
Overall, “Off-pump did not look as good as on-pump,” Grover said.
“Off-pump is not indicated except for certain patients who have issues, such as a heavily calcified aorta,” he explained. That means there’s a lot of plaque build-up in the artery. And, when a pump is used, the aorta has to be clamped. Clamping can cause plaque in the artery to break off and result in a blockage of the heart or brain, Grover said.
Other reasons to use off-pump include patients suffering from liver failure, he said.
The report was published Aug. 17 in the New England Journal of Medicine.
Dr. Joseph Sabik is chairman of the department of surgery at University Hospitals in Cleveland. He said, “Surgery is a technical thing, and a lot of the outcomes depend on how good your surgeon is, particularly, how experienced and technically able the surgeon is with the procedure they are doing.”
Off-pump surgery is technically demanding, so one should have an experienced surgeon, Sabik said. He co-authored an accompanying journal editorial.
“If you select the patients properly, and the surgery is done by an experienced surgeon, then the results can be good,” Sabik said.
Patients who need many grafts may fare better with on-pump surgery, Sabik said, “because you just can’t do it as well as off-pump.”
Elderly patients who may have had a stroke and only need two or three grafts probably do better off-pump, he said.
“Both are very good procedures,” Sabik said. “The key is to have a surgeon experienced with both so that they can choose the right one for you.”
More Information
For more on heart bypass surgery, visit the U.S. National Heart, Lung, and Blood Institute.
SOURCES: Frederick Grover, M.D., professor, surgery, University of Colorado, Aurora; Joseph Sabik, M.D., chairman, department of surgery, University Hospitals, Cleveland; Aug. 17, 2017, New England Journal of Medicine