Beating Heart Bypass Does not Protect Brains

Ivanhoe Newswire
Thursday, February 22, 2007; 12:00 AM

(Ivanhoe Newswire) -- Having bypass surgery with a still-beating heart, instead of using a heart-lung machine, does not prevent mental decline often reported in patients after these procedures.

Cognitive decline is common after bypass surgery. The decline ranges from less than 5 percent to more than 30 percent during the first year after the procedure. The desire to avoid the mental decline has led to a renewed interest in bypass surgery on beating hearts, or off-pump bypass. However, the procedure is technically more demanding.

Researchers from the Netherlands wanted to find out whether off-pump surgery can match the long-term cardiac benefits of on-pump surgery or improve cognitive outcomes. Researchers studied 281 coronary bypass patients. Of these patients, 139 were put on a heart-lung machine during surgery and 142 had surgery with their hearts still beating. Five years later, 130 patients were still alive in each group. Results show half the patients in each group had some cognitive decline.

"The present results suggest that factors other than cardiopulmonary bypass may be responsible for cognitive decline, such as anesthesia and the generalized inflammatory response that is associated with major surgical procedures," conclude the authors. "It is also possible that the cognitive decline observed at five-year follow-up is not caused by the operation, but reflects natural aging."

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SOURCE: The Journal of the American Medical Association, 2007;297:701-708