Off-Pump Bypass Can’t Prevent Mental Decline After Surgery

Disclaimer: Results are not guaranteed*** and may vary from person to person***.

Undergoing surgery on your heart is never an easy thing to face. It’s a serious, frightening experience that carries many risks. Along with the possibility that you may not survive the procedure, there is also the chance that you could experience cognitive damage as well. I know that this is very somber, however, it is an important issue.

 According to a new study, undergoing a heart bypass surgery while your heart is still beating, as opposed to the facilitation a heart-lung machine, will not help prevent the mental decline that so often occurs in a patient after this type of procedure.

 While medical professionals and surgeons have long hoped that not using the machine during the bypass procedure and instead allowing the patient’s heart to keep working would allow for an improvement in the odds of lesser cognitive decline from occurring, according to researchers it’s just not the case.

 Dr. Diederik van Dijk, the study’s author, “It is disappointing that bypass surgery on the beating heart does not translate to better long-term cognitive outcomes when compared to conventional surgery with a heart-lung machine.”

 Typically, by undergoing bypass surgery, a patient faces a five to 30% decline in cognitive functioning up to a year’s time after the procedure. This unfortunate side effect is often unavoidable, and since not undergoing the surgery poses the even greater threat of death, patients don’t have much choice in the matter.

 The researchers were hoping to find that the off-pump method would help reduce the level of cognitive decline that occurs after the procedure, but unfortunately it’s just not so. Some medical experts have held the hope that off- pump surgery could possibly reduce the number of “microemboli” (tiny blood clot fragments, which can make their way to the brain and block smaller arteries, thus causing a reduction in cognitive functioning) in the system.

 However, on a more positive note, Dr. van Dijk did note that “Long-term cardiac outcomes after off-pump surgery are as good as after conventional surgery.”

 In the study, the researchers included 281 patients who had undergone coronary bypass surgery. Out of this group, 139 of the participants were put on a heart-lung machine while the surgeons conducted the procedure as their hearts kept beating. After five years of the initial surgery, 130 of the participants in each group were still living. After six months, the researchers noted that those participants that underwent the bypass while being off-pump had a slight advantage over the heart-lung machine patients. However, after five years, half of the participants from both groups did present with some level of cognitive decline.

 Dr. Frank M. Sellke, the chief of cardiothoracic surgery research at Beth Israel Deaconess Hospital and the vice chairman of the American Heart Association’s council on cardiovascular surgery and anesthesia, also conducted a study on off-pump versus heart-lung machine use during bypass surgery and he found that the results were almost the same for both groups, providing that a skilled surgeon who is familiar with assessing what is best for each individual case.

 According to Dr. Sellke, “. . .whether you do on-pump or off-pump procedures, in the vast majority of cases you are still putting a clamp on the aorta.” As well, he added that the clamp used on the heart’s main artery often “. . .disrupts the inside of the aorta, and those microscopic emboli still go to the brain and other organs.”

 Dr. Sellke’s advice? “I would go to the best surgeon and leave it up to the discretion of that surgeon. I would rather have an on-pump bypass and have the best surgeon.”