| Abstract | BACKGROUND: Neurocognitive impairment can be a debilitating complication after coronary artery bypass graft surgery (CABG). Cardiopulmonary bypass, in particular, cerebral emboli, has been implicated. We compared neurocognitive function and cerebral emboli in patients undergoing on-pump and off-pump CABG. METHODS: 212 patients admitted for CABG were randomly assigned to on-pump (n = 104) or off-pump (n = 108) surgery. Embolic signals were detected with bilateral transcranial Doppler ultrasonography of the middle cerebral artery. Neurocognitive tests were administered preoperatively, on discharge from hospital, at 6 weeks, and at 6 months after surgery. Composite neurocognitive scores were derived using principal component analysis and were compared between the two groups, using analysis of covariance to adjust for baseline values. RESULTS: At discharge from hospital, the adjusted composite neurocognitive score was 0.25 standard deviations greater in the off-pump group compared with the on-pump group (95% confidence interval: 0.05 to 0.45; p = 0.01). There was no significant difference at 6 weeks (0.09 standard deviations, 95% confidence interval: -0.11 to +0.30; p = 0.4) and 6 months (-0.002 standard deviations, 95% confidence interval: -0.23 to +0.23; p = 1.0). Median number of embolic signals was 1,605 (751 to 2,473) during on-pump and 9 (4 to 27) in off-pump CABG (p < 0.001). Age, length of education, and on-pump status were independent predictors of the predischarge neurocognitive score (p = 0.02, 0.03, and 0.006, respectively). CONCLUSIONS: Cerebral emboli are more prevalent during on-pump CABG. At discharge from hospital, neurocognitive function is better after off-pump surgery, possibly as a result of the lower embolic load. However, the difference in neurocognitive function does not persist at 6 weeks and 6 months. |
| Authors | Reza Motallebzadeh, J Martin Bland, Hugh S Markus, Juan Carlos Kaski, Marjan Jahangiri
(Affiliation: Department of Cardiac Surgery, St. George's Hospital Medical School, London, United Kingdom.)
|
| Journal | The Annals of thoracic surgery
(Ann Thorac Surg)
Vol. 83
Issue 2
Pg. 475-82
(Feb 2007)
ISSN: 1552-6259 Netherlands |
| PMID | 17257972
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
|
| Topics |
- Aged
- Cognition
- Coronary Artery Bypass
(adverse effects, mortality)
- Coronary Artery Bypass, Off-Pump
(adverse effects, mortality)
- Female
- Humans
- Intracranial Embolism
(etiology, ultrasonography)
- Intraoperative Complications
- Male
- Middle Aged
- Nervous System
(physiopathology)
- Neuropsychological Tests
- Population Surveillance
(methods)
- Postoperative Period
- Stroke
(etiology)
- Treatment Outcome
- Ultrasonography, Doppler, Transcranial
|
