WEDNESDAY, Jan. 29, 2003 (HealthDayNews) -- Coronary bypass surgery without a heart-lung machine is as successful as surgery with the machine, and it may be less expensive to boot.
That's what Dutch researchers claim in a report that appears in the Jan. 30 issue of the New England Journal of Medicine.
Coronary artery bypass graft surgery (CABG), performed when a person has a blocked artery, involves using a blood vessel from another part of the body to reroute blood around the blocked vessel.
Traditionally, CABG is performed on a stopped heart, while a heart-lung machine keeps the patient alive. "The advantages of using the machine are that the surgeon can operate in a clean, dry field with great precision and at a steady pace without feeling like he's got an ax above his head," explains Dr. Joseph Cunningham, chairman of surgery and director of cardiothoracic surgery at Maimonides Medical Center in Brooklyn, N.Y.
There are, however, some drawbacks to using a heart-lung machine. Some evidence shows the machine might cause inflammation of the lungs, heart, or other organs, Cunningham says. And other studies suggest the machine results in cognitive disorders years down the line.
Finally, some experts believe that patients would have fewer complications and, therefore, a shorter and less expensive hospital stay if no machine was used. In fact, there is some evidence to support this. According to one statistic cited in the study, only 64.5 percent of patients who had been hooked up to the heart-lung machine did not have complications. Longer hospital stays and recovery periods were also noted.
Thus was born a movement to find alternatives to the heart-lung machine. Performing the surgery without a machine rose in New York from 3 percent in 1997 to 27 percent in 2000, notes an accompanying commentary.
This study set out to quantify the differences between the two types of bypass surgery. It looked at 139 patients who had surgery with the machine and 142 who went without it. All the patients were relatively young -- about 61 or 62 years old -- and had only one or two blocked vessels.
After one year, the survival rate and freedom from complications was roughly equivalent: 90.6 percent for the group that had not used a heart-lung machine and 88 percent for the group that had.
To top it off, surgery employing a heart-lung machine was more expensive: $1,839 in additional direct costs per patient, a difference of 14.1 percent.
There are a few caveats. For one thing, the study involved only low-risk patients. "This is a subset of patients who, by all criteria, should be winners to begin with," Cunningham says. "I would expect good results in this particular group of patients."
And although off pump procedure is cheaper, that's "a weak reason to choose one modality over another," Cunningham says. (The cost savings may actually be an illusion. When Cunningham did a cost comparison at his own center, he found the two procedures were identical when it came to cost, possibly indicating price differences between the United States and the Netherlands.)
So, should the pump be on or off?
"The downside of doing something off-pump is that in many situations if you're not selective about the patients you're operating on and the type of artery you decide to bypass, you may end up doing a bypass with less precision," Cunningham says.
"This approach [without a heart-lung machine] is not for everybody," Cunningham says. "There are six ways to skin a cat, and this is just one of them. You have to learn when to use this technology and take advantage of its positive aspects and when to say no."
More information
Check out the American Heart Association for more on bypass surgery and on the history of the heart-lung machine.
