Study, conducted at 18 VA sites, finds edge for traditional 'on pump' method.
Among heart surgeons, a hot debate has centered on the pros and cons of two ways of doing coronary artery bypass surgery.

Conventional "on pump" surgery, around since the middle of the last century, uses a pump that takes over the job of the heart and allows doctors to stop the organ, making it easier to operate. Another method, which has enjoyed renewed interest since the mid–1990s, is "off pump" surgery: It avoids the pump – and some potential complications, according to many experts – but can be a trickier procedure. Now, VA researchers have reported five–year outcomes from more than 2,200 Veterans who underwent heart bypass surgery at 18 VA medical centers between 2002 and 2007. The patients – almost all men, with an average age of around 63, and most having multiple illnesses and two to three diseased blood vessels – had been randomly assigned to traditional "on pump" surgery or the less conventional "off pump" method. The main outcome measure – how many patients died during the five–year follow–up, from any cause – favors the on–pump group. They had an 11.9 percent rate of death, versus 15.2 percent in the off–pump group. This represents a 28 percent higher risk for the off–pump patients.

"This is a moderately sized, clinically relevant difference," notes lead author Dr. A. Laurie Shroyer, lead author on the new report, which appeared online Aug. 17 in the New England Journal of Medicine.

Another outcome the researchers tracked – major adverse cardiac events, such as a nonfatal heart attack or the need for repeat heart procedures – also favored the on–pump group. The rate of such events was 27.1 percent in the on–pump group, versus 31 percent in the other arm of the study. In light of these and other findings from the study, the authors conclude, "It appears that innovative surgical approaches – such as the more technically demanding off–pump procedure – may not always provide superior clinical outcomes."

The upshot of the study, they said, is that on–pump should be the method of choice for most patients needing heart bypass surgery. Certain unusual clinical factors, they said – such as a severely stiffened aorta – could weigh in favor of off–pump.