American Heart Association
Scientific Sessions Presentation: Emory Randomized Trial Finds Off-Pump
Coronary Surgery Cuts Costs And Sends Patients Home Sooner
CHICAGO - The results of the
first U.S. randomized trial comparing off-pump bypass surgery to the
traditional on-pump version of the procedure concludes off-pump surgery
not only offers better results but also reduces the cost of by-pass
procedures by almost $3,000 per patient.
These findings are being
presented at the American Heart Association's Scientific Sessions today
by Emory Crawford Long Hospital cardiothoracic surgeon John Puskas,
M.D., M.Sc, who headed the study's team of Emory University School of
Medicine investigators. "The cost comparison, which is the focus of
my presentation, is very important in this era when health cost containment
is something we are all concerned about," says Dr. Puskas, Associate
Professor of Surgery in Emory University School of Medicine's Division
of Cardiothoracic Surgery.
Coronary artery by-pass graft
surgery (CABG) without the use of the heart-lung machine (known as "off-pump"
surgery) allows cardiothoracic surgeons to provide artery grafts without
stopping the heart, a strategy that may reduce neurological complications
and improve recovery. However, some surgeons have questioned the improved
outcomes reported with off-pump surgery, arguing that the better results
are primarily due to the selection of patients for that technique.
"Before our study, surgeons
were basically comparing apples to oranges -- they were looking at comparisons
between patients who were specifically chosen for off-pump surgery and
those selected specifically for on-pump surgery," explains Dr. Puskas.
"But with the results of our randomized study, no one can make the argument
any longer that the better off-pump results have something to do with
The randomized trial compared
100 patients who received off-pump bypass surgery to 100 patients who
underwent the same procedure but with the on-pump technique. The number
of artery grafts each group received was virtually identical. "We found
that off-pump surgery saves about $2,800 in medical costs," says Dr.
Puskas. "Much of these savings may be due to the fact the patients who
underwent off-pump surgery were able to go home about a day earlier
than the on-pump surgery patients."
In addition, the short term
results of off-pump surgery showed similar or lower rates of death,
heart attack, and stroke when compared to on-pump patients. Off-pump
patients were also on ventilators for a shorter period of time and less
likely to require blood transfusions.
"We believe the major contribution
of our randomized study is that it makes it clear that patient selection
is not an explanation for differences between on-pump and off-pump results.
The bottom line is that you can do a complete job off-pump without any
sacrifice or compromise with the revascularization that is required
for the patient -- and it saves money, too," says Dr. Puskas. "I think
this data will convinced more surgeons to start looking at the advantages
of using the off-pump technique in the future."
The Emory Heart Center
is comprised of all cardiology services and research at Emory University
Hospital (EUH), Emory Crawford Long Hospital (ECLH) Carlyle Fraser Heart
Center, the Andreas Gruentzig Cardiovascular Center of Emory University
and the Emory Clinic. Ranked in the top ten of U.S. News & World Report's
annual survey of the nation's best Heart Centers, the Emory Heart Center
has a rich history of excellence in all areas of cardiology-- including
education, research and patient care. It is also internationally recognized
as one of the birthplaces of modern interventional cardiology.