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Friday, 5 April, 2002, 14:17 GMT 15:17 UK
New surgery offers by-pass hope
'Beating heart' surgery could save the NHS millions
'Beating heart' surgery could save the NHS millions
A pioneering form of heart surgery could reduce the risk of complications for patients, and save the NHS millions.

So-called "beating heart surgery" involves doctors carrying out coronary artery bypass grafts (CABG) while the heart is still beating.

In conventional CABG operations, the heart is stopped and blood is diverted through a heart and lung bypass machine then artificially re-pumped back around the body.

The trial of the beating heart surgery, at Bristol Royal Infirmary, looked at short and medium term outcomes for patients.

We hope that our evidence will encourage more surgeons to use this new technique

Professor Gianni Angelini, Bristol Royal Infirmary
It showed, for the first time, that the technique reduces the risk of chest infections by 12%, irregular fast heart beats by 25%, the need for red-blood cell transfusion by 33% and the need for patients to stay in hospital for more than one week by 13%.

The Bristol findings could have far-reaching consequences affecting how bypass operations are routinely carried out in the future.

About 28,000 CABGs are carried out in the UK each year - at a cost of between 7- 9,000. The new technique could cut the cost of the procedure by up to 30%.

'Positive step'

Professor Gianni Angelini, who carried out the research, estimated 50% of bypass operations could be carried out using the beating heart technique - meaning a saving of up to 30m for the NHS.

Other bypass operations might be particularly difficult, the surgeon may not be able to carry out the new technique, he said.

Professor Gianni Angelini: pioneering research
Professor Gianni Angelini: pioneering research
Professor Angelini uses the technique in around 90% of the bypass operations he performs.

Patients are given bypass operations when an artery in the heart is narrowed or blocked due to coronary heart disease.

An artery or vein from another part of the body is grafted to the heart to "bypass" the narrowed area.

Although the conventional technique is highly successful, stopping the heart and using the heart-lung machine can affect the function of the heart, brain, kidneys and lungs, potentially delaying recovery.

Short-term benefits

Four hundred patients who needed CABGs were randomly allocated to have beating heart ("off-pump") surgery, or traditional "on-pump" technique when the research began in 1997.

In addition to showing benefits in short-term health, researchers also found when patients were followed up one to three years after their operations, there was no difference in outcome between the beating heart or conventional surgery.

In the beating heart group, 2% of patients died from any cause, compared to 3% of the on-pump group.

Research suggesting that a technique that saves resources and is safer for the patient is very important

Sir Charles George, British Heart Foundation
Seventeen per cent of the off-pump group had died, or had a cardiac-related event, compared to 21% of the on-pump group.

Leslie Atthews, 78, speaking less than three days after a triple heart bypass, told the BBC: "I feel, right now, if it wasn't for my sore chest, I'd get up and walk straight out. That's how good I feel."

The research was funded by the British Heart Foundation (BHF) and the Garfield Weston Trust.

Encourage use

BHF Professor Angelini told BBC News Online: "There were two things which allowed us to develop this procedure.

"We devised some small instruments, stabilisers, which will allow is to keep the part of the heart which we are working really still, while the rest of the heart moves.

"We also have means by which we can rotate the heart, or even make it 'stand on its head'."

Leslie Atthews; feels well just three days after a triple heart bypass
Leslie Atthews; feels well just three days after a triple heart bypass
He added: "We hope that our evidence will encourage more surgeons to use this new technique which we have shown can reduce complications and save hospital resources."

He added: "CABG surgery on the beating heart is gaining popularity.

"However, until now there has been a lack of evidence that it improves outcome. Our research shows that it most certainly does."

Other research being carried out by the team indicates the people who benefit most from the beating heart technique are those who have other problems, perhaps in the kidneys or lungs.

The on-pump technique puts pressure on these organs, but the new technique avoids it.

Professor Sir Charles George, medical director of the BHF, said: "Research suggesting that a technique that saves resources and is safer for the patient is very important.

"Without this research, the off pump method of performing CABG was gaining popularity, but with it we have the evidence to show that it is a positive step for patients and hospitals alike."

But the BHF added the current shortage of heart surgeons meant taking doctors away from practice to retrain them would have a knock-on effect on the service.

Click here to go to Bristol
See also:

12 Nov 01 | Health
Steps to speed bypass surgery
28 May 01 | Health
'Revolution' in heart bypass ops
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