Unlike what happens in most coronary bypass surgeries, Liebniz's heart would not be stopped, in hopes of sparing him the brain damage that sometimes follows having a heart-lung machine pump the patient's blood. Despite the technical difficulty of operating on a beating heart, ''off-pump'' coronary bypass has been surging in popularity for the last five years, based on the belief that it reduces the risk of strokes and the mental lapses that occur at least temporarily in a significant number of patients. At Yale-New Haven, the hospital sees a potential marketing advantage in pitching the new method to upscale professionals whose livelihoods depend on mental sharpness. This is the kind of person you want as a donor to the hospital, because they'll be so grateful that you saved their minds,'' said George Annas, a health law specialist at Boston University School of Public Health. That is the worst, most obvious marketing ploy based on no data I've ever seen,'' he said, adding that in his experience, the mental impairment referred to as ''pump head'' is rare in patients under 70.
Surgeons attach new blood vessels to bridge blocked arteries on the surface of the heart.
In standard bypass surgery, the patient's heart is attached by tubes to a heart-lung machine that circulates the blood, while the empty heart lies motionless for the surgeon. Critics question whether the bypass operations done off the pump are as thorough and effective as those done while the heart is motionless. The major debate, however, is over the ''neuropsychological'' side effects. Enthusiasts say patients getting the off-pump surgery need fewer blood transfusions, are more alert afterward, and, in some centers, go home earlier. The idea of a bypass that doesn't leave the patient foggy-headed has proved immensely appealing for doctors.