Medical Society Reaches Consensus on ‘Beating Heart’ Bypass Surgery

Earlier this month, the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS; Beverly, MA) concluded in a consensus statement that off-pump coronary artery bypass surgery (OPCAB), or ‘beating heart’ surgery, is as safe and effective as conventional coronary artery bypass surgery and may even be more appropriate for certain at-risk patients. The statement followed a 19-month review of clinical data and outcomes over the last decade comparing OPCAB with traditional procedures that require use of a heart-lung machine.

“This effort represents the first and most extensive review of all studies related to OPCAB,” says John Puskas, MD, of Emory University’s Crawford Long Hospital (Atlanta), who coauthored the statement. “It’s clear that this growing body of medical evidence suggests that off-pump procedures are safe, effective, and easier on the patient than conventional coronary artery bypass graft (CABG) surgery.” The ISMICS consensus statement on off-pump coronary bypass surgery was developed in accordance with clinical practice standards of the American College of Cardiology (Bethesda, MD).

“Once again, there is a persuasive story to the benefits of beating heart surgery,” says Oern Stuge, MD, senior vice president and president of cardiac surgery at Medtronic Inc. (Minneapolis). “We expect that more physicians will continue to embrace, and more patients will continue to request, this surgical approach.” Numerous medtech manufacturers, including Medtronic, supply a wide range of stabilizers, positioners, and other devices used in OPCAB procedures.

During conventional CABG surgery, the heart is stopped and a heart-lung machine is used to pump and oxygenate the patient’s blood. In OPCAB procedures, stabilizers, positioners, and advanced surgical instruments are used to suture a graft on an isolated area of a beating heart without requiring the use of a heart-lung machine.

ISMICS noted in its statement that at-risk patients are often better suited for the OPCAB procedure. They identified these at-risk patients as those with advanced age, diabetes, renal problems, or a history of stroke or heart attack. According to the researchers, for reasons not entirely understood, women also presented a unique group when compared to men. Women generally had better outcomes with beating heart surgery versus traditional CABG surgery.

The authors stressed, however, that the choice of surgery type is not black and white. The individual patient’s presenting condition and past history are the most important indicators in determining the optimum procedure, they said.

In the United States, an estimated 350,000 patients a year undergo CABG surgery. In the general population, approximately 25% of these procedures are performed off-pump. This increases to 30% for age 65 and over Medicare patients. The procedure dates back to the 1960s, and the number of CABG procedures performed on patients with coronary artery disease has steadily declined since the introduction of, and subsequent advances in, angioplasty and drug-eluting stents.

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