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Ann Thorac Surg 2002;74:400-406
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Neurological outcomes in coronary surgery: independent effect of avoiding cardiopulmonary bypass

Nirav C. Patel, FRCS(C-Th)a, Anand P. Deodhar, MChb, Antony D. Grayson, BSc, D. Mark Pullan, FRCS(C-Th)a, Daniel J.M. Keenan, FRCSb, Ragheb Hasan, FRCS(C-Th)b, Brian M. Fabri, MD, FRCS(Ed)*a

a Department of Cardiothoracic Surgery, The Cardiothoracic Centre-Liverpool, Liverpool, United Kingdom
b Department of Research and Development, The Cardiothoracic Centre-Liverpool, Liverpool, United Kingdom
c Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, United Kingdom

* Address reprint requests to Dr Fabri, The Cardiothoracic Centre-Liverpool, Thomas Drive, Liverpool L14 3PE, United Kingdom
e-mail: bfabr{at}ccl-tr.nwest.nhs.uk

Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.

Background. Recent studies examining neuroprotective effects of off-pump coronary artery bypass grafting (CABG) have shown inconsistent results. We examined our database to quantify the independent effects of avoidance of cardiopulmonary bypass (CPB) and aortic manipulation on neurologic outcomes after CABG.

Methods. A total of 2,327 consecutive cases undergoing isolated CABG between April 1997 and May 2001 were identified at our two institutions. Patients were divided into three groups: on CPB, off-pump with aortic manipulation, and off-pump without aortic manipulation. To control for the confounding effects of other risk factors, we performed a multivariate logistic regression analysis. Potential covariates considered in the logistic model included age, sex, redo operations, diabetes, chronic obstructive pulmonary disease, neurologic disease, peripheral vascular disease, ejection fraction, and priority of operation.

Results. A total of 1,210 cases were performed on CPB, compared with 520 off-pump with aortic manipulation, and 597 off-pump without aortic manipulation. The incidence of focal neurologic deficit was 1.6% (n = 19) in the on-pump group, 0.4% (n = 2) in the off-pump with aortic manipulation group, and 0.5% (n = 3) for the off-pump without aortic manipulation group (p for trend = 0.027). The results of the multivariate logistic regression analysis demonstrated that use of CPB was a risk factor for focal neurologic deficit, with an odds ratio of 3.82 (95% confidence interval, 1.41 to 10.34; p = 0.005). Aortic manipulation did not significantly influence neurologic outcome in off-pump patients.

Conclusions. Off-pump operation, with or without aortic manipulation, reduces adverse neurologic outcomes compared with on-pump procedures.




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