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June 20, 2003


Emory Research Presented At International Conference Today Shows for First Time Off-Pump By-Pass Surgery Offers Dramatic Benefits for Diabetics

SAN FRANCISCO -- Coronary artery by-pass graft surgery (CABG) without the use of the heart lung machine allows cardiothoracic surgeons to provide artery grafts without stopping the heart, a strategy that research conducted at Emory University School of Medicine has shown may offer numerous benefits to patients and improve recovery. Now there's new data from Emory researchers showing that the off-pump approach offers substantial benefits for diabetic patients undergoing CABG.

The new research comparing off pump to on pump CABG surgery in diabetics -- the first randomized, controlled study of its kind in the world -- was presented here today by Emory Crawford Long Hospital cardiothoracic surgeon John Puskas, MD, who headed the Emory research team, at the annual meeting of the International Society for Minimally Invasive Cardiac Surgery (ISMICS).

The Emory study compared the results of about thirty diabetic patients who underwent off-pump CABG with a similar number who had CABG while on the heart/lung machine. The Emory researchers randomized the patients, who were unselected for coronary anatomy, and then rigorously documented that there were the same number of grafts in both groups. Graft patency was assessed in both groups with anteriograms.

"We found that the completeness of revascularization and graft patency were similar in both groups, as was the mortality rate after thirty days. But the diabetics were substantially better off with off-pump surgery in every other way, " Dr. Puskas concludes. "The off-pump patients were less likely to require blood transfusions, had less injury to their hearts and were quicker to get their breathing tubes removed. They also went home sooner and overall hospital and professional costs were significantly less for the off-pump group. Anyway you look at it, diabetic patients undergoing CABG surgery did better off-pump rather than on-pump."

Dr. Puskas points out that stents, tiny mesh-like tubes frequently used to keep arteries open after they have been cleared of atherosclerotic plaques by angioplasty, are becoming better and more frequently used to help patients with cardiovascular disease -- however, they are problematic for people with diabetes who have heart disease.

"Diabetics tend to do poorly with angioplasty and stents. They tend to have restenosis, a reclogging of their stents at angioplasty sites, much more quickly and more often than non-diabetic patients," Dr. Puskas explains. "So, traditionally, diabetic patients have been sent for CABG rather than angioplasty. As off-pump surgery becomes more and more popular, we needed to document whether diabetics, who tend to have a lot of additional health problems, did at least as well with off-pump surgery as with on-pump. We've done that and our positive findings will provide an important sense of comfort for cardiologists who are referring diabetic patients for cardiac surgery and for surgeons doing the beating heart surgery."

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