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Original Articles: Cardiovascular

Neurocognitive Outcomes of Off-Pump Versus On-Pump Coronary Artery Bypass: A Prospective Randomized Controlled Trial

^a Eastern Maine Medical Center, Bangor, Maine
^b The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
^c Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Accepted for publication July 11, 2007.

^_* Address correspondence to Dr Hernandez, Cardiothoracic Surgery, Eastern Maine Medical Center, 417 State St, Suite 421, Bangor, ME 04401 (Email: fhernandez{at}emh.org).

Presented at the Poster Session of the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: Preliminary reports have documented the safety of off-pump coronary artery bypass graft compared with conventional coronary artery bypass graft surgery. Whereas off-pump coronary artery bypass graft surgery may be associated with improvement in some short-term outcomes, longer-term outcomes and influence on neurocognitive function have not been fully assessed. We examined short-term and intermediate-term neurocognitive and index admission morbidity and mortality after coronary artery bypass surgery performed with and without the use of extracorporeal circulation.

Methods: We prospectively randomly assigned 201 patients undergoing nonemergent isolated coronary artery bypass graft surgery to conventional coronary artery bypass graft surgery (n = 102) or off-pump coronary artery bypass graft surgery (n = 99). The primary end points of the study were neurocognitive function assessed using a 19-test neurocognitive battery at baseline, discharge, and 6 months. Neurocognitive deficit was defined as a 20% or greater reduction from baseline in at least 20% of the tests. Secondary end points included index admission mortality, stroke, low-output cardiac failure, return to the operating room for bleeding, and postoperative troponin release. Risk ratios and 95% confidence intervals were calculated based on intention-to-treat analysis.

Results: There was no difference in neurocognitive deficit at discharge (discharge versus preoperative: risk ratio, 0.83; 95% confidence interval, 0.65 to 1.07) or at 6 months (6 months versus preoperative: risk ratio, 0.94; 95% confidence interval, 0.70 to 1.28). There was no significant difference in mortality or morbidity between the two groups. The off-pump coronary artery bypass graft group had fewer patients with troponin release than the conventional coronary artery bypass graft group.

Conclusions: Off-pump coronary artery bypass graft surgery did not result in decreased frequency of neurocognitive deficit. Off-pump coronary artery bypass graft surgery was associated with substantially lower levels of troponin release after surgery.