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November 18 , 2002


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 patient selection."

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.


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