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Ann Thorac Surg 1999;68:1469
© 1999 The Society of Thoracic Surgeons
a Department of Anaesthesia, University of Western Ontario, London, Ontario, Canada
b Department of Surgery, University of Western Ontario, London, Ontario, Canada
Background: Adverse neurological and cognitive sequelae have been documented to occur with significant frequency after routine coronary artery bypass grafting (CABG) surgery using cardiopulmonary bypass (CPB). Surgical strategies addressing this significant problem have included epiaortic scanning and off-pump coronary revascularization (OPCAB). While epiaortic scanning has been shown to accurately identify and optimize aortic cannulation and clamp sites, shearing of atherosclerotic plaque as a consequence of ‘jet’ perfusion from the aortic cannula during CPB still results in microparticulate cerebral embolization. Up to 40% of conventional CABG patients have evidence of cognitive deterioration on neuropsychological testing at 3 months postoperatively. The role of OPCAB in improving neurological outcomes is presently only theoretical. We hypothesized that the incidence of neurologic and cognitive dysfunction would be significantly lower in patients undergoing off-pump coronary artery bypass.
Methods: In this study, 68 patients underwent a standard battery of 9 neuropsychological tests preoperatively and 5 days and 3 months postoperatively. Thirty-five OPCAB patients were compared with 33 patients who underwent conventional CABG with extracorporeal circulation and cardioplegic cardiac arrest. A 20% decrease in change score on 20% or more of tests was defined as ‘cognitive dysfunction’ and group results were compared using Fischer’s exact test.
Results: OPCAB patients demonstrated a significantly lower incidence of NP dysfunction at 5 days (66% vs 90% respectively, p = 0.025) and 3 months postoperatively (5% vs 50% respectively, p = 0.0011) compared with conventional CABG patients.
Conclusions: OPCAB significantly reduces the incidence of postoperative neurological and cognitive dysfunction in patients undergoing coronary artery revascularization.
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