Advantages and disadvantages of off-pump bypass surgery, from the Harvard Heart Letter

When surgeons devised ways to operate on a beating heart, many believed this approach would phase out the use of the heart-lung machine, the device that paved the way for life-saving open heart surgery. Not so, reports the March 2013 Harvard Heart Letter.

The heart-lung machine, first used in 1953, adds oxygen to blood and circulates it around the body. This lets doctors stop the heart, making it safer and easier to bypass cholesterol-clogged coronary arteries or fix other cardiac problems. While the machine helped save and improve countless lives, some experts blamed the heart-lung machine (also known as the pump) for the foggy thinking and memory loss that sometimes follows bypass surgery. In an effort to avoid this problem, surgeons developed ways to operate on the heart while it continued to beat, avoiding the pump.

Yet "off-pump" bypass surgery hasn't eliminated use of the heart-lung machine. In fact, it is still used in three-quarters of bypass operations. Most experts agree that off-pump bypass surgery makes sense for people who are at high risk for developing complications from the heart-lung machine, like those who have had a stroke or have a fragile aorta, the body's largest blood vessel. But among people at normal risk, surgeons remain divided on the use of off-pump bypass.

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