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Media Contact: Lance Skelly 20 April 2004
  lance.skelly@emory.edu    
  (404) 686-8538 ((40) 4) -686-8538   Print  | Email ]
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Emory Study Finds 'Beating Heart' Bypass Offers Medical Benefits, Cost Savings
The landmark Surgical Management of Arterial Revascularization Trial (SMART), conducted by Emory Heart Center researchers and published in the April 21 issue of the Journal of the American Medical Association (JAMA), not only provides evidence of the medical benefits of coronary artery bypass graft (CABG) surgery performed while patients' hearts continue to beat -- it also suggests that the wide adoption of this surgical approach, which avoids use of the heart/lung machine, could provide enormous economic savings.

"We found that the acute cost savings was about $2,272 per patient. Multiplied by the number of CABG procedures performed annually in the U.S., that would hypothetically yield a national savings approaching one billion dollars," says Emory Crawford Long Hospital cardiothoracic surgeon John Puskas, MD, who headed the SMART team.

Research has shown that coronary artery bypass graft (CABG) surgery performed while patients' hearts continue to beat can result in faster recovery time than traditional CABG procedures that stop the heart and rely on a heart/lung pump to maintain circulation. But solid evidence that off-pump coronary artery bypass (OPCAB) is as effective as on-pump CABG in restoring blood flow to the heart muscle and maintaining revascularization over time has been lacking -- until now.

"SMART demonstrates for the first time that in unselected patients OPCAB can achieve similar graft patency acutely and at one year as traditional CABG. That means that we are accomplishing the same revascularization for the patient, while providing a host of other benefits including less blood loss and less damage to hearts during surgery," says Dr. Puskas. "There does not need to be a trade-off of efficacy to get those benefits."

SMART involved 197 patients -- the largest U.S. group that has participated in a prospective, randomized, blinded study comparing off-pump to on-pump CABG surgery. Unlike previous studies comparing on-pump to off-pump CABG, patients were not selected according to coronary anatomy and ventricular function and were not excluded if they had other health problems. All received either on-pump or off-pump CABG performed by Dr. Puskas at Emory Crawford Long Hospital in Atlanta. In his beating-heart procedures, Dr. Puskas used Medtronic's Octopus tissue stabilizer, a device which holds the beating heart's surface tissue nearly stationary as the bypass graft is sutured in place.

Restoration of blood flow to the heart was demonstrated in angiograms prior to discharge from the hospital, and graft durability and patency (freedom from blockage) was confirmed in angiograms conducted on research participants one year after surgery. Only twenty-six percent of beating-heart patients required blood transfusions compared to forty-nine percent of patients undergoing traditional CABG. In addition, beating-heart patients were able to breathe on their own sooner after surgery, spent less time in intensive care and left the hospital an average of one day earlier than CABG patients who had been placed on the heart/lung machine during surgery.

Media Contact: Lance Skelly 20 April 2004
  lskelly@emory.edu    
  (404) 686-8538   Print  | Email ]
Share:

del.icio.us

Emory Study Finds 'Beating Heart' Bypass Offers Medical Benefits, Cost Savings
The landmark Surgical Management of Arterial Revascularization Trial (SMART), conducted by Emory Heart Center researchers and published in the April 21 issue of the Journal of the American Medical Association (JAMA), not only provides evidence of the medical benefits of coronary artery bypass graft (CABG) surgery performed while patients' hearts continue to beat -- it also suggests that the wide adoption of this surgical approach, which avoids use of the heart/lung machine, could provide enormous economic savings.

"We found that the acute cost savings was about $2,272 per patient. Multiplied by the number of CABG procedures performed annually in the U.S., that would hypothetically yield a national savings approaching one billion dollars," says Emory Crawford Long Hospital cardiothoracic surgeon John Puskas, MD, who headed the SMART team.

Research has shown that coronary artery bypass graft (CABG) surgery performed while patients' hearts continue to beat can result in faster recovery time than traditional CABG procedures that stop the heart and rely on a heart/lung pump to maintain circulation. But solid evidence that off-pump coronary artery bypass (OPCAB) is as effective as on-pump CABG in restoring blood flow to the heart muscle and maintaining revascularization over time has been lacking -- until now.

"SMART demonstrates for the first time that in unselected patients OPCAB can achieve similar graft patency acutely and at one year as traditional CABG. That means that we are accomplishing the same revascularization for the patient, while providing a host of other benefits including less blood loss and less damage to hearts during surgery," says Dr. Puskas. "There does not need to be a trade-off of efficacy to get those benefits."

SMART involved 197 patients -- the largest U.S. group that has participated in a prospective, randomized, blinded study comparing off-pump to on-pump CABG surgery. Unlike previous studies comparing on-pump to off-pump CABG, patients were not selected according to coronary anatomy and ventricular function and were not excluded if they had other health problems. All received either on-pump or off-pump CABG performed by Dr. Puskas at Emory Crawford Long Hospital in Atlanta. In his beating-heart procedures, Dr. Puskas used Medtronic's Octopus tissue stabilizer, a device which holds the beating heart's surface tissue nearly stationary as the bypass graft is sutured in place.

Restoration of blood flow to the heart was demonstrated in angiograms prior to discharge from the hospital, and graft durability and patency (freedom from blockage) was confirmed in angiograms conducted on research participants one year after surgery. Only twenty-six percent of beating-heart patients required blood transfusions compared to forty-nine percent of patients undergoing traditional CABG. In addition, beating-heart patients were able to breathe on their own sooner after surgery, spent less time in intensive care and left the hospital an average of one day earlier than CABG patients who had been placed on the heart/lung machine during surgery.



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