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Ann Thorac Surg 2000;69:1162-1166
© 2000 The Society of Thoracic Surgeons

ORIGINAL ARTICLES: CARDIOVASCULAR

Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation

Anno Diegeler, MDa, Robert Hirsch, MDa, Felix Schneider, MDa, Lars-Oliver Schilling, MDa, Volkmar Falk, MDa, Thomas Rauch, PhDa, Friedrich W. Mohr, MD, PhDa

a Department of Cardiac Surgery, Herzzentrum, Universität Leipzig, Leipzig, Germany

Address reprint requests to Dr Diegeler, Department of Cardiac Surgery, Herzzentrum, Universität Leipzig, Russenstraße 19, D-04289 Leipzig, Germany

Background. Cardiopulmonary bypass seems to be a major cause for both intraoperative microemboli and cerebral hypoperfusion. This study investigates high intensive transient signals (HITS) in transcranial Doppler ultrasound (TCD) and serum levels of the neurobiochemical marker protein S-100 in patients who underwent coronary artery bypass operation without cardiopulmonary bypass (off-pump CABG) in comparison with the conventional procedure using cardiopulmonary bypass (CPB). The results are related to the neuropsychologic outcome in both surgical groups.

Methods. Forty patients were randomized in 2 groups (20 conventional and 20 off-pump CABG). Neurocognitive status was assessed preoperatively and postoperatively. Venous serum levels of S-100 protein were measured before and after coronary operation, HITS were measured in the middle cerebral artery during the operation.

Results. The median value of HITS was 394.5 (0 to 2217) in the conventional versus 11 (0 to 50) in the off-pump group, p less than 0.0001 (Table 1). Postoperative S-100 serum levels were: 3.76 (0.13 to 11.2) µg/L (conventional) versus 0.13 (0.04 to 1.01) µg/L (off-pump), p less than 0.0001. Postoperative cognitive testing showed significantly different results with a postoperative impairment of 90% of the patients in the conventional group versus no impairment in the off-pump group.

Conclusions. Cognitive impairment seems to be strongly associated to CPB and the occurrence of microemboli. The off-pump technique appears to be promising in order to eliminate the source of these neuropyschologic impairments following CABG operation.




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M. Perthel, S. Kseibi, A. Bendisch, and J. Laas
The dynamic bubble trap reduces microbubbles in extracorporeal circulation and high intensity transient signals in the middle cerebral artery: a case report
Perfusion, September 1, 2003; 18(5): 325 - 329.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
F. F. Immer, P. A. Berdat, A. S. Immer-Bansi, F. S. Eckstein, S. Muller, H. Saner, and T. P. Carrel
Benefit to quality of life after Off-Pump versus On-Pump coronary bypass surgery
Ann. Thorac. Surg., July 1, 2003; 76(1): 27 - 31.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
A. Parolari, F. Alamanni, A. Cannata, M. Naliato, L. Bonati, P. Rubini, F. Veglia, E. Tremoli, and P. Biglioli
Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials
Ann. Thorac. Surg., July 1, 2003; 76(1): 37 - 40.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
D. J. Goldstein, R. B. Beauford, B. Luk, R. Karanam, T. Prendergast, F. Sardari, P. Burns, and C. Saunders
Multivessel off-pump revascularization in patients with severe left ventricular dysfunction
Eur. J. Cardiothorac. Surg., July 1, 2003; 24(1): 72 - 80.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Goto, T. Baba, K. Matsuyama, K. Honma, M. Ura, and T. Koshiji
Aortic atherosclerosis and postoperative neurological dysfunction in elderly coronary surgical patients
Ann. Thorac. Surg., June 1, 2003; 75(6): 1912 - 1918.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
R. Ascione and G. D. Angelini
Off-pump coronary artery bypass surgery: The implications of the evidence
J. Thorac. Cardiovasc. Surg., April 1, 2003; 125(4): 779 - 781.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
A. M.A. Keizer, R. Hijman, D. van Dijk, C. J. Kalkman, and R. S. Kahn
Cognitive self-assessment one year after on-pump and off-pump coronary artery bypass grafting
Ann. Thorac. Surg., March 1, 2003; 75(3): 835 - 838.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. Bucerius, J. F. Gummert, M. A. Borger, T. Walther, N. Doll, J. F. Onnasch, S. Metz, V. Falk, and F. W. Mohr
Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients
Ann. Thorac. Surg., February 1, 2003; 75(2): 472 - 478.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
R Ascione and G.D Angelini
OPCAB surgery: a voyage of discovery back to the future
Eur. Heart J., January 2, 2003; 24(2): 121 - 124.
[Full Text] [PDF]

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 PerfusionHome page
A. Mazzone, J. Gianetti, E. Picano, S. Bevilacqua, G. Zucchelli, A. Biagini, and M. Glauber
Correlation between inflammatory response and markers of neuronal damage in coronary revascularization with and without cardiopulmonary bypass
Perfusion, January 1, 2003; 18(1): 3 - 8.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
A. G. Cerillo, L. Sabatino, S. Bevilacqua, P. A. Farneti, M. Scarlattini, F. Forini, and M. Glauber
Nonthyroidal illness syndrome in off-pump coronary artery bypass grafting
Ann. Thorac. Surg., January 1, 2003; 75(1): 82 - 87.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
J. Laas, S. Kseibi, M. Perthel, A. Klingbeil, L'E. El-Ayoubi, and A. Alken
Impact of high intensity transient signals on the choice of mechanical aortic valve substitutes
Eur. J. Cardiothorac. Surg., January 1, 2003; 23(1): 93 - 96.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
R. Ascione, M. Caputo, and G. D. Angelini
Off-pump coronary artery bypass grafting: not a flash in the pan
Ann. Thorac. Surg., January 1, 2003; 75(1): 306 - 313.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
V. Pignay-Demaria, F. Lesperance, R. G. Demaria, N. Frasure-Smith, and L. P. Perrault
Depression and anxiety and outcomes of coronary artery bypass surgery
Ann. Thorac. Surg., January 1, 2003; 75(1): 314 - 321.
[Abstract] [Full Text] [PDF]

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 Card Surg AdultHome page
J. W. Hammon Jr. and L. H. Edmunds Jr.
Extracorporeal Circulation: Organ Damage
Card. Surg. Adult, January 1, 2003; 2(2003): 361 - 388.
[Full Text]

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 Card Surg AdultHome page
R. Salenger, J. S. Gammie, and T. J. Vander Salm
Postoperative Care of Cardiac Surgical Patients
Card. Surg. Adult, January 1, 2003; 2(2003): 439 - 469.
[Full Text]

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 Card Surg AdultHome page
V. Vijay and J. P. Gold
Late Complications of Cardiac Surgery
Card. Surg. Adult, January 1, 2003; 2(2003): 521 - 537.
[Full Text]

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 Card Surg AdultHome page
T. M. Dewey and M. J. Mack
Myocardial Revascularization Without Cardiopulmonary Bypass
Card. Surg. Adult, January 1, 2003; 2(2003): 609 - 625.
[Full Text]

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 SEMIN CARDIOTHORAC VASC ANESTHHome page
C. S. Hollenbeak, D. L. Morris, and M. C. Sinclair
Is Off-pump Coronary Artery Bypass Graft Surgery Cost-Saving?
Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2002; 6(4): 325 - 329.
[Abstract] [PDF]

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 BMJHome page
V. Zamvar, D. Williams, J. Hall, N. Payne, C. Cann, K. Young, S Karthikeyan, and J. Dunne
Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: prospective randomised controlled trial
BMJ, November 30, 2002; 325(7375): 1268 - 1268.
[Abstract] [Full Text] [PDF]

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 Crit Care NurseHome page
C. Chen-Scarabelli
Beating-Heart Coronary Artery Bypass Graft Surgery: Indications, Advantages, and Limitations
Crit. Care Nurse, October 1, 2002; 22(5): 44 - 58.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
K.-B. Kim, C. H. Kang, W.-I. Chang, C. Lim, J. H. Kim, B. M. Ham, and Y. L. Kim
Off-pump coronary artery bypass with complete avoidance of aortic manipulation
Ann. Thorac. Surg., October 1, 2002; 74(4): S1377 - 1382.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
M. Mack, D. Bachand, T. Acuff, J. Edgerton, S. Prince, T. Dewey, and M. Magee
Improved outcomes in coronary artery bypass grafting with beating-heart techniques
J. Thorac. Cardiovasc. Surg., September 1, 2002; 124(3): 598 - 607.
[Abstract] [Full Text] [PDF]

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 NEJMHome page
A. Diegeler, H. Thiele, V. Falk, R. Hambrecht, N. Spyrantis, P. Sick, K. W. Diederich, F. W. Mohr, and G. Schuler
Comparison of Stenting with Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery
N. Engl. J. Med., August 22, 2002; 347(8): 561 - 566.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
S. C. Stamou, K. A. Jablonski, A. J. Pfister, P. C. Hill, M. K.C. Dullum, A. S. Bafi, S. W. Boyce, K. R. Petro, and P. J. Corso
Stroke after conventional versus minimally invasive coronary artery bypass
Ann. Thorac. Surg., August 1, 2002; 74(2): 394 - 399.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
N.C. Patel, A.D. Grayson, M. Jackson, J. Au, N. Yonan, R. Hasan, and B.M. Fabri
The effect off-pump coronary artery bypass surgery on in-hospital mortality and morbidity
Eur. J. Cardiothorac. Surg., August 1, 2002; 22(2): 255 - 260.
[Abstract] [Full Text] [PDF]

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 PerfusionHome page
R. Ascione, S. Al-Ruzzeh, K. Amer, and G. D Angelini
Subsystem organ function during coronary surgery
Perfusion, July 1, 2002; 17(4): 295 - 303.
[Abstract] [PDF]

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 JAMAHome page
F. M. Fouad-Tarazi, J. Feldschuh, S. M. F. Malheiros, A. R. Massaro, E. Buffolo, D. Venes, W. T. C. Yuh, C. J. Knott-Craig, M. D. Tilak, D. van Dijk, et al.
Cognitive Outcomes Following Cardiopulmonary Bypass
JAMA, June 19, 2002; 287(23): 3077 - 3079.
[Full Text] [PDF]

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 Asian Cardiovasc. Thorac. Ann.Home page
E. W. Jansen
Invited Commentary
Asian Cardiovasc Thorac Ann, June 1, 2002; 10(2): 158 - 159.
[Full Text] [PDF]

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 JAMAHome page
D. Van Dijk, E. W. L. Jansen, R. Hijman, A. P. Nierich, J. C. Diephuis, K. G. M. Moons, J. R. Lahpor, C. Borst, A. M. A. Keizer, H. M. Nathoe, et al.
Cognitive Outcome After Off-Pump and On-Pump Coronary Artery Bypass Graft Surgery: A Randomized Trial
JAMA, March 20, 2002; 287(11): 1405 - 1412.
[Abstract] [Full Text] [PDF]

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 JAMAHome page
D. B. Mark and M. F. Newman
Protecting the Brain in Coronary Artery Bypass Graft Surgery
JAMA, March 20, 2002; 287(11): 1448 - 1450.
[Full Text] [PDF]

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 J Am Coll CardiolHome page
H. L. Karamanoukian, H. W. Donias, and J. Bergsland
Decreased incidence of postoperative stroke following off-pump coronary artery bypass
J. Am. Coll. Cardiol., March 6, 2002; 39(5): 917 - 917.
[Full Text] [PDF]

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 PerfusionHome page
D C Whitaker, J Stygall, and S P Newman
Neuroprotection during cardiac surgery: strategies to reduce cognitive decline
Perfusion, March 1, 2002; 17(2_suppl): 69 - 75.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
O. Chavanon, M. Durand, R. Hacini, H. Bouvaist, M. Noirclerc, T. Ayad, and D. Blin
Coronary artery bypass grafting with left internal mammary artery and right gastroepiploic artery, with and without bypass
Ann. Thorac. Surg., February 1, 2002; 73(2): 499 - 504.
[Abstract] [Full Text] [PDF]


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