Trillium In The News

Globe and Mail

Study Bolsters Bypass Technique

Keeping the heart beating found to be as effective and cheaper than the heart-lung machine

April 21, 2004

Doing the heart bypass surgery while the heart is still beating is just as effective as traditional surgery, but costs significantly less, according to new research.

The so-called beating-heart surgery also allows much sicker patients to undergo bypass surgery safely, and results in fewer complications, according to a study published in today’s edition of the Journal of the American Medical Association.

“There are very few procedures that are better for the patient and cheaper for the health system, so we should be embracing beating-heart surgery,” said Dr. Gopal Bhatnagar, head of cardiac surgery at Trillium Health Centre in Mississauga, and Canada’s leading practitioner of beating-heart surgery.

Dr. Bhatnagar was not involved in the new research, but was not surprised by the results. He said that at Trillium, where 80 per cent of bypass procedures are done while the patient’s heart is still beating, each surgery saves about $2,000 over the traditional method, largely because there are fewer complications.

Coronary artery bypass surgery uses blood vessels to reroute blood flow around arterial blockages to improve the supply of blood and oxygen to the heart. There are about 50,000 bypasses performed annually in Canada.

During conventional bypass surgery, a heart-lung machine allows the heart to stop and pumps blood through throughout the body; it also means a patient needs to be on a ventilator. The three most frequent complications related to heart surgery-stroke, lung failure and kidney failure-are all due to the use of the heart-lung machine.

With beating-heart surgery, also known as off-pump surgery, the heart is kept beating and a device is used to stabilize the heart while the surgeon places bypass grafts around the blocked arteries.

The biggest knock against beating-heart surgery is that it is technically more difficult for the surgeon and the anesthetist. There were also concerns about its long-term effectiveness, but those have largely been laid to rest by this study.

The study, led by Dr. John Puskas of the Emory School of Medicine in Atlanta, was conducted on 197 patients, who underwent bypass surgery. The rates of stroke, heart attack and angina were similar with both methods following the procedures. “There were no significant differences in health-related quality of life,” Dr. Puskas said.

Dr. Bhatnagar noted, however, that in the United States, surgery is offered to much sicker patients than in Canada. Beating-heart surgery is particularly effective for patients with conditions such as diabetes, lung disease, kidney problems and obesity, who often cannot tolerate time on the heart-lung machine.

“We need to start looking at these procedures from a patient point of view. The onus is on us to provide the operations patients need, not just the ones we want to do,” he said.

In the United States, the beating-heart method is used in more than one in five bypass surgeries. There are no good data in Canada, but the figure is believed to be much lower.

Dr. Bhatnagar said that, generally speaking, Canadian surgeons have been too slow to embrace beating-heart surgery. “It’s difficult to talk about this and still be polite, but there’s a certain inertia, a reluctance to change and move on from what’s comfortable,” he said.

Dr. Bhatnagar said that while every surgeon should not be obliged to do beating-heart surgery, every cardiac program in Canada should offer it as an option to patients.

He said that, from a system perspective, one of the great benefits of beating-heart surgery is that patients recover more quickly and free up beds.

In an editorial published in today’s edition of JAMA, Eric Peterson of the Duke University Medical Center in Durham, N.C., said the new study demonstrates that beating-heart surgery is as good, if not better, than traditional bypass surgery, and it may well become the “new standard.” But, he said, a larger study needs to be conducted, and particular emphasis placed on recruiting high-risk patients.

Media Contacts

For all media enquiries, please call Public Relations at 905-848-7580 ext. 3832.