Is beating-heart surgery better? Opinions vary
by Stephanie Esters | Kalamazoo Gazette
Thursday April 02, 2009, 8:30 AM
New local doctor prefers it, but others find best results with traditional procedure
KALAMAZOO — The addition of a new physician to a local cardiac practice means that more patients will be offered the option of open heart surgery without the use of a heart-lung machine.
But whether this method is more beneficial to patients seems to be a matter of some disagreement and to depend heavily on a surgeon’s experience and ability with the procedure.
This type of procedure — called off-pump surgery or, as Rashid prefers, beating-heart surgery, is typically used on heart patients who are sicker than most, who might have other pre-existing diseases and conditions or who might have calcified aortas, Rashid said.
Dr. Zahir Rashid
In addition, off-pump surgeries have the potential for reducing the risk of bleeding, stroke and kidney failure and the need for blood transfusions, according to the University of Maryland Medical Center’s Web site.
But there’s not a consensus that off-pump surgery is better than on-pump.
Dr. Michael Khagany, president of Cardio Thoracic Surgery, contends that "truly there is no advantage of off-pump over on-pump."
"It is technically more demanding (to perform off-pump surgery) … because the heart is moving under you," Khaghany said.
Although someone has off-pump surgery approximately every 10 minutes in this country, more than 70 percent of all bypass surgeries are performed on a stopped heart, reports the Web site of Medtronic Inc.
Khagany said most of the surgeons at his practice prefer the on-pump method — using a heart-lung machine to keep the heart beating and lungs breathing — because they have found that patients heal better after on-pump surgery.
He cited a January 2003 New England Journal of Medicine report on a study of 281 low-risk patients in the Netherlands, about half of whom had on-pump surgery and half off-pump. The study found there was no difference between the two groups in terms of the cardiac outcome a year following the surgery, Khagany said.
Off-pump surgeries have been performed in Kalamazoo since 1978. But the number of such surgeries done by Cardio Thoracic Surgery doctors — who practice at both Kalamazoo hospitals — has dwindled in recent years because the physicians were not experiencing as much success with the off-pump procedure, Khaghany said.
About 85 percent of the open heart procedures done by the local surgeons are on-pump surgeries, versus 15 percent for off-pump, according to Khaghany.
Before leaving Kalamazoo for Erie, Pa., Rashid’s predecessor, Dr. Mark Marby, performed the bulk of the off-pump surgeries done by the surgeons from the local practice, although he was doing fewer by the time he left the practice in October 2007, Khaghany said.
At one point during Marby’s time in Kalamazoo, as many as 30 percent of his open-heart surgeries were done off-pump, but near the end of his time with the practice he was doing only about 5 percent off-pump, Khaghany said.
The local surgeons’ group found that the bypass grafts done during the off-pump heart surgery didn’t stay open as long as they needed to, creating a post-surgery complication for the patient, Khagany said.
"One has to be very careful, very good, to do this, and Dr. Rashid is a good surgeon," Khaghany said. "But you have to be very careful about the life of this graft, that they stay open."
Rashid has performed more than two dozen of the off-pump surgeries since joining Cardio Thoracic Surgery in mid-January. Since he began doing off-pump surgery nine years ago, he’s done about 1,100 such procedures, he estimates.
He acknowledged that on-pump surgery "has the established track record — good job, good outcome."
But he also sees lots of potential for off-pump surgery. "This is something that we are trying to improve the outcome (of)," he said. "We do have some success, but some failure, too. It all depends on how good is a particular surgeon."
And the key factor, of course, is what is best for the patient, he said. "As long as it’s good for the patient, we’ll do it."
Is beating-heart surgery better? Opinions vary - Kalamazoo, Michigan Living News - The Kalamazoo Gazette – MLive.com
