New heart surgery studies show benefit of off-pump approach

Geisinger data used in national studies

WILKES BARRE - Off-pump cardiac artery bypass graft (CABG) surgery significantly improves success rates in women and in patients requiring multiple grafts, two groups who are not often considered off-pump candidates, according to two studies presented at the recent Society of Thoracic Surgeon’s Conference in San Diego.

Both national studies included data from Geisinger Heart Institute, where nearly 94 percent of all CABG surgery is performed off-pump.
CABG surgery is a procedure to help patients with blockages in their heart arteries. During the procedure, a surgeon creates a detour around the blocked artery so blood can flow to the heart.
Due to the high incidence of coronary artery disease worldwide, as well as the effectiveness of this surgical procedure, CABG surgery is one of the 10 most frequently performed procedures in North America. More than 13,000 procedures are performed each year in Pennsylvania, according to the Pennsylvania heart data report, 2004 PHC-4.
In traditional CABG, the heart is stopped and a heart-lung machine does the work of the heart and lungs. But during off-pump CABG surgery, the surgeon uses new kinds of operating equipment and technological advances to perform the procedure on a beating heart, eliminating the need for a heart-lung machine.

“It stands to reason that this minimally invasive option would decrease the risk of complications such as stroke, renal failure, infection and the need for a blood transfusion,” said Alfred Casale, MD, Director of Surgery for the Geisinger Heart Institute.  “It may also lessen the risk of cognitive changes that are seen in patients who undergo CABG with the heart-lung machine. These short-term changes include memory loss, difficulty thinking clearly and problems concentrating.”

“Geisinger has extraordinary experience in off-pump cardiac surgery,” added Dr Casale, estimating that Geisinger heart surgeons have performed about 1,750 off-pump procedures over the past five years.

Regardless of the number of grafts a patient receives, Emory University researchers found that off-pump CABG surgery increases the success rate by decreasing complications seen in traditional CABG surgery. These include stroke, renal failure and the need for blood transfusion. The study cites data, including numbers from Geisinger, from more than 11,000 patients.

Even more compelling were results of a study showing that women have better success rates with off-pump rather than traditional CABG surgery. Women, who have more complications with traditional CABG surgery than their male counterparts, showed significantly better overall results.

 Authored by members of the Society of Thoracic Surgeons Database Committee, upon which Dr Casale has previously served, the study looked at outcomes of 42,000 people undergoing CAB over two years using The Society of Thoracic Surgeons National Cardiac Database. The data represents 63 North American heart centers, including Geisinger.
More than half of the patients studied were older females with conditions that put them at greater risk of complications than their male counterparts.
“These studies present significant results,” said Dr. Casale, “They confirm what our electronic health record data told us was true.”
Geisinger Heart Institute is widely recognized as a leader in off-pump cardiac surgery. About 94 percent of bypass operations at Geisinger are performed off-pump compared to about 20 percent nationally. Geisinger has had an off-pump program for the past 10 years, and is recognized nationally as an early adopter of this procedure.

"Clearly we are providing the most technologically advanced care for our patients,” Casale said.

The studies were presented at the Society for Thoracic Surgeon’s annual meeting in San Diego in late January.
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