NEJM 5 Nov 2009 Vol 361
1827 Coronary artery bypass grafting has become the commonest surgical operation in the world, we keep being informed, though I bet that isn’t counting circumcision. Still, everyone who isn’t Jewish, Muslim, American or male can still have CABG so it obviously wins on some higher criterion of ubiquity. Eighty percent of it is still performed using a cardiopulmonary bypass pump to help the surgeon by keeping the heart still. These pumps are known to generate debris and causing microemboli, which have been held responsible for the cognitive impairment often seen after open heart procedures. Innovative cardiothoracic surgeons have argued for off-pump CABG and here they show willingness to put their assertions to the test of a randomised trial. As the accompanying editorial (p.1897) notes, this in itself should be seen as an enormous success. As for the result: sorry innovators, off-pump patients fare slightly worse by criteria of graft completion and late patency, and no better in neuropsychological assessments. http://content.nejm.org/cgi/content/abstract/361/19/1827
No comments:
Post a Comment