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Sharon Grant · #1 (**permalink**) 12-02-2005, 02:26 PM

ISMICS Publishes Consensus Statement on Beating Heart Bypass Surgery in INNOVATIONS

Statement Concludes That Beating Heart Surgery Is Safe and Reduces Complications Compared to Traditional Bypass Surgery BEVERLY, Mass.,

Dec. 1 /PRNewswire/ -- The International Society forMinimally Invasive Cardiothoracic Surgery (ISMICS) announced today the resultsof a meta-analysis and Consensus Statement of off-pump coronary artery bypasssurgery (OPCAB). The Consensus Statement concluded that OPCAB, or beatingheart bypass surgery, is safe and reduces many of the complications and costsof conventional coronary artery bypass surgery (CCAB).

In May 2004 ISMICS, an international organization of cardiothoracicsurgeons with special interest in minimally invasive surgery, held a ConsensusConference to review data from multiple studies and to compare clinicaloutcomes after OPCAB with conventional bypass surgery during which the heartis stopped and the patient's blood redirected to a heart-lung machine. Theconclusions of the discussion and testimony presented by the Consensus Panelat the Conference have been chronicled in an evidence-based ConsensusStatement and published in the peer-reviewed journal, INNOVATIONS.

After review, the Consensus Panel concluded that with appropriate use ofmodern stabilizers, heart positioning devices and adequate surgeon experience,OPCAB is not only as safe as CCAB, but also reduces complications and usesfewer hospital resources. Beating heart surgery is associated with reductionsin atrial fibrillation, red blood cell transfusion, low cardiac output andrespiratory infections. This benefit is even more striking for certain"high-risk" patients -- women, the elderly, diabetic, dialysis patients andpatients with aortic disease or poor left ventricular function -- whotypically have poorer outcomes following bypass surgery.

"Beating heart surgery is an advance in cardiac surgery because itprovides a better result for patients," said John Puskas, MD, co-author of theConsensus Statement, Associate Professor of Surgery at Emory University andChief of Cardiothoracic Surgery and Director of the Clinic Research UnitDivision of Cardiothoracic Surgery at Emory Crawford Long Hospital, Atlanta."We carefully looked at all the literature and came to the conclusion that onseveral important points, beating heart patients came out ahead, especially ifthey were high-risk patients. Interestingly, women qualify as a high-riskgroup all by themselves. For reasons that we do not understand very well,women do not do as well during coronary bypass surgery as men. We believe thatthey will do better with beating heart surgery than with the conventionaloperation and the use of a heart-lung machine, all other things being equal."

Coronary artery bypass graft (CABG) is one of the most frequentlyperformed operations, with approximately 30 percent of these proceduresundertaken "off pump" or with the heart continuing to beat. There has beenincreasing interest in techniques that avoid the risks associated with theconventional operation and the use of a heart-lung machine. New techniques,such as beating heart procedures, together with new stabilization devices,attempt to improve upon an operation which has been refined over 40 years andwhich yields excellent clinical outcomes.

The International Society for Minimally Invasive Cardiac Surgery (ISMICS)was formed to organize and centralize the various surgical centers concernedwith patient outcomes, techniques and progressive development of less invasiveforms of heart surgery. Formed in 1997 by the participants of the WorldCongress of Minimally Invasive Cardiac Surgery at the Palais Des Congres,Paris, France, the new ISMICS is taking the leadership role in shaping thedirection of less invasive cardiac surgery on a global basis. The foundingmembership includes representatives from all continents. INNOVATIONS is theofficial journal of ISMICS. It will publish papers about developments thatoffer to make the treatment of cardiothoracic and vascular disease lessinvasive than it has been.

ksamolyk · #2 (**permalink**) 12-02-2005, 06:13 PM

It's important to look at everything! I agree that Op-Cabs have a place in certain Patient populations generally Pts with vessels that are easy to get to on top of the heart and those with heavily calcified aortas, but this technology is not the panacea that ISMICS portrays. I have seen Pts severely struggle with arrhythmias and BP drops that even border on arrests and even actual arrests with MI's that have to crash on CPB because the surgeon wants to prove that he can do these types of procedures. (Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial) http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15691685 Everyone knows that it is easier to sew on a bloodless motionless target than to make a patient that is already very sick work 2-3 times as hard and literally struggle for there life while they torque the heart up and out of the chest so they can visualize the intended target for grafting. There are certain surgeons that do this type of procedure all the time and they are very good at it, and they should be the ones doing it! but those surgeons that only dabble in this type of extremely invasive procedure should not!
The height of this technology has already peaked a few years ago at the mid 20% range of cases being done and is now on the way down to the mid teens nationally.
Technically it is a better operation to be done on pump and more grafts are done on CPB that stay open longer than off pump. Think of it this way, how many times are they going to be inside your chest in your lifetime? wouldn't you want them to do the most that they could with the best possible grafts while your heart was rested or would you rather have them do less grafts on a moving target with blood in the field and make you struggle for your life when you are the most compromised. Conventional CPB grafting with a standard sternotomy has an overall mortality rate of 2% nationally, nothing else even comes close.