Coronary Bypass: On Pump or Off?

I have written and thought a lot recently about coronary bypass surgery. Here are the articles. One article says a heart-lung machine might cause brain damage in some cases; and according to this article, “stopping the heart and passing the blood through a heart-lung machine . . . frequently leads to ‘whole body inflammation,’ which includes complications such as brain swelling, heart arrhythmia and infections.” So having read these articles I had pretty much decided that having a bypass operation performed on a beating heart, i.e., without the heart-lung machine, would be the way to go if I ever needed such an operation.

Now, however, this article says that the off pump procedure is no better at preventing mental decline after five years than the procedure using the heart-lung machine. In fact, after five years half of the patients who had undergone each procedure showed mental decline. That’s pretty depressing. It just reinforces my opinion that you want to do everything you can do to avoid needing to have a bypass. That means eating right (vegetarian, no hydrogenated oil), watching your fat and cholesterol, exercising, not smoking, etc.

So there are basically two opinions about coronary bypass operations as stated in the above article:

(Dr.) Sellke said he favors on-pump bypass in his own practice. His advice for people facing bypass surgery: "I would go to the best surgeon and leave it up to the discretion of that surgeon. I would rather have an on-pump bypass and have the best surgeon."

But van Dijk had a different view. "Because it is conceivable that off-pump surgery decreases the risk of perioperative stroke -- although definite evidence for this is not available yet -- I would personally prefer to undergo an off-pump procedure, and I would recommend the same to patients who have an increased risk of this terrible perioperative complication," he said.

I think I tend to favor off-pump too. But I guess if we ever need a bypass that will be the time to decide. President Clinton had the on pump operation, so it must not be too bad. But he also had his bypass in the eighth best hospital in the country. We can’t all be that lucky, however I do live relatively close to Duke which is number seven . . . .


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