Bypass surgery done on a beating heart is just as effective as the conventional operation performed with a heart-lung machine, and less expensive, a study found.
Previous research reached conflicting conclusions on the benefits of the new beating-heart technique, with one study finding that the newly grafted blood vessels are far more likely to become clogged up three months after surgery in those who undergo the procedure.
The new study, published in Wednesday's Journal of the American Medical Association, examined nearly 200 patients three months after surgery, and again after a year, and found no significant differences in quality of life between those who had the beating-heart technique and those who were connected to a heart-lung machine during their operation.
The rates of death, stroke, heart attack and the need for additional surgery also were comparable.
In addition, the two groups were found to be similar in how much - or how little - their new vessels became blocked.
Earlier findings from the same group of patients showed that those who underwent the beating-heart technique had fewer problems immediately after surgery and were released from the hospital a day earlier.
The savings averaged about $2,300 a patient, said Dr. John D. Puskas of Emory University in Atlanta, who performed all the operations and has been a pioneer of the method.
"Off-pump surgery is technically more challenging for the surgeon to perform, and I think it is also clear that it is easier for the patient to have it performed on them,'' Puskas said.
Puskas said about one-fifth of all bypass operations are now performed without a heart-lung machine and he expects the proportion to grow as more surgeons become comfortable with the procedure.
During conventional bypass surgery, the patient's heart is stopped and a heart-lung machine circulates the blood while surgeons attach new blood vessels to create a detour around clogged ones.
But the machine - first used in 1953 - is thought to increase the risk of stroke, damage to the heart and kidneys, and possibly mental decline, because it can cause clots or air bubbles.
The beating-heart technique uses devices developed in the 1990s to hold the heart still during surgery.
The new study is unlikely to end the controversy over the procedure, since it involved just 200 operations performed by the same surgeon who pioneered the technique.
But a former president of the American Heart Association, Dr. Sidney Smith, a professor of medicine at the University of North Carolina, said the findings are "very encouraging.''
Of 197 patients, 98 underwent off-pump surgery and 99 underwent the standard bypass. Four in each group died within a year of the operation.
Quality of life was assessed through questionnaires that asked patients to rate such things as their ability to perform usual activities, their pain and their general health.
The heart-lung machine is still preferred for people with irregular heart rhythm or blood pressure, or those suffering a cardiac crisis, Puskas said.