Performing bypass surgery while the heart is still beating -- called off-pump heart surgery -- has many benefits for patients, a group of Honolulu doctors has found. Off-pump heart surgery
may lessen patients’ riskRecovery is quicker and costs are
less, says a study by Hawaii doctorsModerate drinking may decrease heart-attack
By Helen Altonn
haltonn@starbulletin.comIn the first study of its kind, a team led by Dr. Jeffrey D. Lee, chief of the Division of Cardiothoracic Surgery at St. Francis Medical Center, showed that bypass surgery done without using a heart-lung machine reduces trauma, bleeding and damage to the brain.
Recovery is quicker, decreasing the hospital stay to 4.5 days from about 5.4 and cutting costs per patient by about $5,500, Lee said.
Jeffrey Lee and Dr. Shay J. Lee, with St. Francis' department of nuclear medicine, described their results this week at the American Heart Association's Asia Pacific Scientific Forum at the Convention Center. Other doctors at St. Francis, Straub Clinic & Hospital and the Pacific Health Research Institute participated in the study from April 1999 to last September.
In an interview, Jeffrey Lee noted that traditional bypass surgery, done in about 90 percent of cases, involves use of a heart-lung machine or pump to stop the heart so the surgery can be performed.
The machine is called a pump because it pumps oxygen and nutrients to the body during surgery.
In off-pump heart surgery, a device is used that sucks the heart into the tip of a cup that can be pulled out of the chest and rotated as the surgeon wants, Jeffrey Lee said.
Another device applies pressure to hold blood vessels steady while blood continues flowing so the surgeon can perform the bypass on a motionless field.
About 60 bypass patients agreed to participate in the study and envelopes were pulled in the operating room designating whether surgery would be on or off the pump, the doctors said.
The off-pump group had 40 percent less blood loss and 70 percent reduction in blood transfused, Jeffrey Lee said.
"What was exciting was the reduction in blood usage and time in the hospital reduced the cost (by) $5,500 per patient," he said.
About 60,000 bypasses a year are done in the United States, with 10 percent off the pump, he said.
If twice the number of procedures were done with the heart beating, it would save the United States $33 million in medical costs that could be used for vaccines or other purposes, he said.
There may be some exceptions, but the procedure conceivably could be used for all bypass patients, Lee added.
He said there is a 3 percent risk of stroke after a traditional procedure, affecting 1,800 of those getting bypasses in a year. Reducing that by one-third with off-pump surgery would prevent 600 strokes a year and keep people from losing their memory or going into nursing homes, he said.
Shay Lee studied neurological complications, looking at the brain before and after surgery with a SPECT scan to assess blood flow. The scans showed more microemboli, abnormal particles circulating in the blood, were going to the brain after traditional surgery, leading to more strokes, he said.
The doctors believe the bypass pump or tubing used to reroute blood back into the body stirs up debris in the aorta to the brain.
Evaluating patients' brain function, Shay Lee found scans were abnormal for those with traditional bypasses and normal for those off the pump.
The results were "very surprising," Jeffrey Lee said. "When we talk about memory problems, patients look fairly normal," but tests showed memory and intellectual capacity were reduced, he said.
"Clinically, we know they come out better" with off-pump surgery, he added. "But up to this date, no one really proved it is better. ... We encourage other doctors to use it."
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Moderate alcohol drinking may have healthy effects if a person has a certain slow-metabolizing enzyme, says a German scientist. Moderate drinking may
decrease heart-attack
risk, researcher saysBy Helen Altonn
haltonn@starbulletin.comArmin Imhof of the University of Ulm was among nearly 900 researchers reporting the latest findings related to cardiovascular research and epidemiology at the American Heart Association's Asia Pacific Scientific Forum here this week.
Red Morrison, AHA Hawaii executive director, said it was decided to hold a second Asia Pacific Scientific Forum here next year and it may continue after that.
The scientists covered a broad range of medical issues, from increasing hypertension in China and a link between higher testosterone levels and risk for coronary vascular disease to benefits of vitamin D in reducing risk of heart disease for women over age 65 and genes that may predict atherosclerosis.
Imhof conducted a study of 2,815 drinking and nondrinking men and women. About 20 percent drank beer exclusively, 15 percent drank only wine, 1 percent hard liquor and others a mixture, he said.
Using AMA guidelines, he said moderate drinking amounts to about two drinks per day for men and one for a woman.
His research identified a variant in a gene for a particular enzyme, alcohol dehydrogenase type 3 (ADH3), that alters the rate of alcohol metabolism.
Those with the slower metabolizing ADH3 gene showed effects that may represent decreased risk of heart attack, he said.
Among highlights of other studies discussed at the forum:
>> Scientists in Chicago and Seattle discovered higher levels of testosterone during young adulthood "may contribute to the development of coronary calcification in men, particularly black men." >> University of California San Francisco researchers studied 9,704 women age 65 and older and found those who took vitamin D, both a hormone and a vitamin, had nearly one-third less risk of dying from heart disease than women who did not take the supplements.
>> Japanese scientists studying immigrants from Japan in Hawaii found younger members begin to lose the habit of eating soy products. A dietary study of two groups, one eating a soy-free diet and others getting at least 25 grams of soy protein daily, showed those with the soy diet had significantly lower blood pressures and cholesterol levels. Thus, middle-aged men and women taking more than 25 grams a day of soy protein have reduced risk of cardiovascular disease, the researchers said.
>> Doctors at Kaiser Permanente in Oakland, Calif., studied 16,305 women who had routine mammography between 1964 and 1973 at Kaiser hospitals and found women whose routine mammograms revealed calcification in their breasts' blood vessels were at increased risk for stroke; those who had calcification only in milk ducts were not.