Patients Undergoing Beating Heart Surgery May Be At Increased Risk

Coronary artery bypass surgery performed whilst the heart is still beating may carry an increased likelihood of death, according to a systematic review by Cochrane researchers. The researchers suggest beating heart surgery should not be recommended except in specific cases where stopping the heart might be risky.

Heart surgery in patients with heart disease caused by narrowed arteries has for many years been performed "on-pump", by stopping the heart and introducing a bypass to artificially pump the patient's blood. It is now possible to perform surgery without stopping the heart, using stabilisation devices. This "off-pump" approach is intended to reduce complications. However, previous systematic reviews found high quality evidence was lacking.

The new review included 86 trials, involving a total of 10,716 patients. According to the results, rather than improving outcomes for patients, off-pump approaches actually increased the risk of death slightly when compared with on pump bypass. Overall, the risk increased from 3.1% on-pump to 3.7% off-pump. Patients enrolled in many of the trials were on average younger and with a lower risk of complications than patients typically undergoing coronary artery bypass surgery. The majority of trials had a high risk of bias and short follow-up. But, when the researchers carried out an analysis of ten trials that had low risk of bias and long follow-up, the gap between on-pump and off-pump became wider, with the risk of death increasing from 4.6% on-pump to 6.2% off-pump.

"Our data raise a warning regarding coronary artery bypass surgery performed while the heart is beating," said lead researcher Christian Møller of the Department of Cardiothoracic Surgery and The Copenhagen Trial Unit at The Copenhagen University Hospital in Copenhagen, Denmark. "By comparison, the traditional on-pump method seems less risky and, based on this evidence, should remain the standard surgical treatment."

However, beating heart surgery may be a better option in certain patients for whom stopping the heart poses a particular risk. The researchers say more high quality trials are required to improve the evidence base. "We need more trials assessing the potential benefit of beating heart approaches in patients with contraindications to on-pump surgery," said Møller. "In these patients, off-pump could still be considered."

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Plastic Surgery - Enormous Increase In Uptake By Younger Women

Professor Laurence Kirwan, one of the world's leading plastic surgeons, who has appeared on BBC Breakfast to comment on the PIP breast implant scandal and who wrote in the Mail on Sunday (British newspaper) how cosmetic surgery can prolong life, has said that more and more young women between the ages of 35 and 40 years have cosmetic surgery.
Professor Kirwan says that the number of women between 35 and 40 years who have cosmetic surgery every single year for 5 years has risen by 5%.
He says that most young women opt for 'liquid lifts', injections of facial fillers, which typically consist of hyaluronic acid, a gel-like substance that occurs naturally in the skin and helps retain moisture to make cheeks look fuller and lift sagging jaws. The 'liquid lifts' together with Botox freeze the muscles to lift drooping eyebrows by interfering with nerve transmission.
Younger women tend to choose a short-scar facelift (SSFL), whereby the skin is pulled upwards and then pulled back over the bony structures of the face, whilst fat pads that have dropped with aging are repositioned into their proper place. This new and nonintrusive procedure only has a maximum two-week down time costs about £10,000 ($16,000) with results lasting for as long as 10 years.
Kirwan says:

"This is a miracle treatment for many young women wanting to cut off the effects of ageing at the pass. They don't want to wait until they look older. They strike in advance. It is the perfect choice for those seeking to turn back the clock. It redefines the lower face, jawline and upper neck. It lifts the mid-face and the only visible sign it leaves is a 0.4in scar tucked into the crease where the ear joins the cheek. The rest of the incisions are hidden in the hairline and the back of the ear."

Many younger women also choose mini-facelifts, like the one-stitch facelift whereby the surgeon removes a semi-circle of skin at the hairline at the top of the ear, which pulls up the skin and tissues over the cheeks as the wound is stitched together. This 30-minute procedure is performed under local anesthetic and costs about £2,000 ($3,200) but only lasts 1 year.
This procedure instantly 'refreshes' a woman's look and because it only leaves a small scar hidden in the hairline, nobody will ever be any the wiser.
Professor Kirwan, who is a member of the British Association of Aesthetic Plastic Surgeons, explains:

"Surgical techniques have become significantly more refined in the past decade and the surgery is tailored to the individual while retaining a very natural result."

According to Kirwan, the demand for plastic surgery has increased by 250% in two years, with facelifts currently being amongst the top three procedures at his surgery.
The British Association of Aesthetic Plastic Surgeons published new figures that show a 4.7% to 4,700% rise in demand in 2011 for surgical facelifts performed by their organization members.
"The growing acceptance of Botox and fillers by women under 30 has made the step-up to cosmetic surgery much less scary," explains Kirwan, continuing that younger women recommend cosmetic surgery to their friends, with the result that more and more younger women choose to have surgery.
He says:

"If it's the done thing in the young social circle and the results are fantastic, then this is playing a major part in why so many younger women are opting for cosmetic procedures."

Written by Petra Rattue
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Petra Rattue. "Plastic Surgery - Enormous Increase In Uptake By Younger Women." Medical News Today. MediLexicon, Intl., 16 Mar. 2012. Web.
17 Mar. 2012. APA

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'Plastic Surgery - Enormous Increase In Uptake By Younger Women' Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.
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