[HSF] AATS on vs off pump

[Tea Acuff]

Just a few thoughts over the next few days on some of the presentations at AATS. There was a prospective randomized trial of 120 patients with STMI for urgent CAB. Somewhat counter intuitively Off  Pump had less cardiogenc shock and lower mortality (6% vs 1%, p=.04) and the usuall less LOS. The discussant mentioned that his interest was in arterial revascularization and had little experience with either acute MI surgery or, I presumed off pump, but was not surprised that as with the PCI vs CABG comparison only "high risk" patients will show a difference. 
As for my thoughts if one's concerns are arterial conduits, for example, one will likely not see the attraction or benefit of OFF pump and many of us have other concerns than strict mortality or periop benefits. Secondly I would like to propose that the impact of simple and often impulsive formative acts such as "naming" a concept or procedure is considerable to how we handle the same. If we had named off pump surgery and its "alternative" differently, say beating heart verses arrested heart surgery, this paper would not be counter intuitive but the opposite. It would be logical and "obvious" that arrest is bad for the heart until proven otherwise.
tea