Health Matters: Risks equal with on- and off-pump bypass
Q. I need to have heart bypass surgery. My cardiac surgeon mentioned the procedure could be done "on-pump" or "off-pump." What does that mean, and does it make a difference?
A. On- or off-pump refers to whether you are placed on a heart-lung machine during surgery, which in your case will consist of the placement of one or more tubes that go around (or "bypass") any blockages you have in your coronary arteries (the blood vessels that feed the heart itself). The common tubes that are used are the artery behind your breastbone (the internal mammary artery), the end of which is sewn in place, and the artery in your forearm (the radial artery), which is removed and then sutured in place in your chest.
Sewing the arteries on a moving heart has been a challenge, so in the past, almost all bypass surgery was done with the heart stopped and the patient kept alive by a heart-lung machine that did the work of the heart and lungs.
But we've now learned how to do the same bypass operation on a beating heart, so it can be done without the use of the heart-lung machine (that is, off-pump). And a recent study of almost 5,000 patients showed that as of about five years after surgery, there was no difference in the risk of death, stroke, kidney failure, the need for a repeat procedure or cost in a group of patients who had their bypasses performed on-pump compared with those off-pump. So you'll likely have a great outcome regardless of whether the operation is done on- or off-pump.
Q. I have a bad family history of coronary heart disease, so if it is preordained that I'm going to get it, too, why worry about things like diet and exercise?
A. Unfortunately, you are quite right that inheritance plays an important role in predicting one's risk for coronary heart disease (that is, blockages in the arteries that bring blood to the heart). It turns out that by looking at the genetic information contained in blood cells, scientists have found that people with high-risk patterns have about double the risk of developing a heart problem than those at low risk. But in addition to family history, we also know that several so-called risk factors (such as high blood pressure, diabetes, cigarette smoking, and others) also increase one's risk of heart disease. So is it worth it to pay attention to them if you're bound to get heart problems because of your family history? The bottom line is yes. Since none of us can select our parents, the genes that we inherit from them are simply a fact of life.
But what about those risk factors that you easily can modify such as diet, smoking, exercise and
controlling your weight? It turns out that regardless of your genes, you can lower your risk by about half if you address those risk factors. That means even if your risk is doubled by your genetics, you can reduce your risk by half by doing simple stuff such as exercising and not smoking. So get with the program.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences and a professor of medicine. He is a cardiologist by training.
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The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.