BOSTON, MA – The September Harvard Heart Letter tries to make sense of what the American Heart Association calls "one of the most hotly debated and polarizing issues in cardiac surgery"—whether traditional bypass surgery or the newer off-pump bypass procedure is better.
Traditional bypass surgery uses a pump that temporarily takes over the work of the heart and lungs. This heart-lung machine lets a surgeon work on a motionless muscle—a plus when sewing spaghetti-thin blood vessels. However, the machine can also trigger tiny blood clots and loosen bits of plaque from the aorta. This debris can travel to the brain, possibly causing a stroke or contributing to the mental fog that sometimes follows bypass surgery.
Off-pump bypass surgery uses a device that immobilizes only the section of the heart with the diseased artery, so the rest of the heart can carry on its work. There are some concerns that beating-heart grafts may not last as long as those done on a motionless heart. It's also possible that off-pump bypass may limit the number of blood vessels operated on since it can be harder to get at some parts of the heart with this technique.
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