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.

An American Heart Association panel recently concluded that both types of bypass are equally safe and effective. If you’ve been advised to have bypass surgery, the Harvard Heart Letter suggests that you ask your surgeon if one type is better for you than the other and work together to choose one. What matters more than the type of bypass are how many bypasses your surgeon does each year (more than 100 is good) and how many are done in your hospital (more than 200 is good).

Also in this issue:

Benefits of home blood pressure checks Using Crestor and other statins safely What to do when your pacemaker or defibrillator is recalled