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Ann Thorac Surg 2003;76:765-770
© 2003 The Society of Thoracic Surgeons
a Department of Neurology, Oslo, Norway
b The Interventional Centre, Oslo, Norway
c Department of Thoracic and Cardiovascular Surgery, Oslo, Norway
d Department of Psychosomatic Medicine, Oslo, Norway
e Department of Radiology, Rikshospitalet University Hospital, Oslo, Norway
Accepted for publication April 3, 2003.
* Address reprint requests to Dr Lund, Department of Neurology, Rikshospitalet University Hospital, 0027 Oslo, Norway;
e-mail: christian.lund{at}rikshospitalet.no
BACKGROUND: Coronary artery bypass surgery with cardiopulmonary bypass carries a significant risk of perioperative brain injury. At least 1% to 5% will suffer a stroke, and at 3-months postoperatively approximately 30% are reported to have cognitive impairment assessed by neuropsychologic testing. In off-pump surgery cardiopulmonary bypass is not used and instrumentation on the ascending aorta is reduced. The main aim of this study was to assess if off-pump surgery reduces intraoperative cerebral embolization.
METHODS: This was a prospective and randomized study of two comparable groups with regard to age, sex, years of education, preoperative cognitive functioning, and surgical characteristics. Fifty-two patients (29 off-pump) were monitored by the use of transcranial Doppler ultrasound for cerebral microembolization during surgery. Preoperative and postoperative clinical, cerebral magnetic resonance imaging, and neuropsychologic examinations were also carried out.
RESULTS: There was a significant reduction in the number of cerebral microemboli during off-pump compared with on-pump surgery (16.3 [range 0 to 131] versus 90.0 [range 15 to 274], p < 0.0001). No significant difference with regard to the incidence of neuropsychologic performance (decline in 29% off-pump, 35% on-pump) or neuroradiologic findings at 3 months was found, and there was no association between the number of cerebral microemboli and cognitive outcome.
CONCLUSIONS: This study clearly demonstrates that off-pump surgery leads to a reduction in intraoperative cerebral microembolization. A significant reduction in the number of off-pump patients with cognitive decline or ischemic brain lesions on cerebral magnetic resonance imaging could not be demonstrated in this relatively small patient population.
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|
|
|
|
|
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|
|
|
|
|
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|
|
|
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