News Release: Research , School of Medicine

Jan. 27,  2010

Off-pump Bypass Surgery Benefits Reinforced in Landmark Study

Long-term results from the landmark SMART (Surgical Management of Arterial Revascularization) study provide confirmation of the effectiveness of performing coronary artery bypass graft surgery while the patient's heart continues to beat, a procedure known as off-pump coronary artery bypass.

Findings were presented by lead investigator, John Puskas, MD, professor of surgery and associate chief, Division of Cardiothoracic Surgery, Emory University School of Medicine on Tuesday, Jan. 26 at the Society of Thoracic Surgeons' 46th Annual Meeting in Fort Lauderdale, Fla.

Results of the SMART study, initiated in 2000, were published in April 2004 by the Journal of the American Medical Association. It was the first randomized US trial to compare off-pump coronary artery bypass (OPCAB) with conventional coronary artery bypass graft surgery (CABG) surgery, and the research showed CABG surgery performed on a beating heart without a heart-lung machine is medically beneficial. Patients recovered faster with OPCAB than with conventional CABG. Findings also showed it was as effective as CABG in restoring blood flow and maintaining revascularization to the heart muscle over time.

Long-term follow-up data collected from SMART study patients confirm that outcomes are similar based on an analysis of early- and late-graft patency (freedom from blockage), incidence of recurrent heart attack, need for re-intervention, and long-term survival between the two procedures at a mean of nearly eight years after surgery.

"These long-term follow-up data provide additional evidence that the early benefits of OPCAB are not obtained at the expense of long-term survival or freedom from re-intervention," says Puskas.

Data confirming the durability of off-pump surgery complement conclusions from numerous previous studies showing that OPCAB offers significant post-operative patient benefits by reducing the risk of complications. This is particularly true among high-risk patients, such as those with other medical conditions, including diabetes, a history of stroke, or poor physical health, or the elderly, obese and women, who typically do not fare as well under conventional cardiopulmonary bypass procedures.

"The SMART follow-up data add to the growing body of evidence supporting the long-term durability of OPCAB, including randomized studies performed in the U.K. and 10-year follow-up of CABG patients at our university," says Puskas. 

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