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Neurocognitive function and cerebral emboli: randomised study of on-pump versus off-pump coronary artery bypass surgery

Motallebzadeh, R., Bland, J.M., Markus, H.S., Kaski, J.C. and Jahangiri, M. (2007) Neurocognitive function and cerebral emboli: randomised study of on-pump versus off-pump coronary artery bypass surgery. The Annals of Thoracic Surgery, 83 (2). pp. 475-482. ISSN 0003-4975

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Background Neurocognitive impairment can be a debilitating complication after coronary artery bypass graft surgery (CABG). Cardiopulmonary bypass, in particular, cerebral emboli, has been implicated. We compared neurocognitive function and cerebral emboli in patients undergoing on-pump and off-pump CABG.

Methods 212 patients admitted for CABG were randomly assigned to on-pump (n = 104) or off-pump (n = 108) surgery. Embolic signals were detected with bilateral transcranial Doppler ultrasonography of the middle cerebral artery. Neurocognitive tests were administered preoperatively, on discharge from hospital, at 6 weeks, and at 6 months after surgery. Composite neurocognitive scores were derived using principal component analysis and were compared between the two groups, using analysis of covariance to adjust for baseline values.

Results At discharge from hospital, the adjusted composite neurocognitive score was 0.25 standard deviations greater in the off-pump group compared with the on-pump group (95% confidence interval: 0.05 to 0.45; p = 0.01). There was no significant difference at 6 weeks (0.09 standard deviations, 95% confidence interval: −0.11 to +0.30; p = 0.4) and 6 months (−0.002 standard deviations, 95% confidence interval: −0.23 to +0.23; p = 1.0). Median number of embolic signals was 1,605 (751 to 2,473) during on-pump and 9 (4 to 27) in off-pump CABG (p < 0.001). Age, length of education, and on-pump status were independent predictors of the predischarge neurocognitive score (p = 0.02, 0.03, and 0.006, respectively).

Conclusions Cerebral emboli are more prevalent during on-pump CABG. At discharge from hospital, neurocognitive function is better after off-pump surgery, possibly as a result of the lower embolic load. However, the difference in neurocognitive function does not persist at 6 weeks and 6 months.

Item Type: Article
Institution: The University of York
Academic Units: The University of York > Health Sciences (York)
Depositing User: York RAE Import
Date Deposited: 11 Feb 2009 12:11
Last Modified: 11 Feb 2009 12:11
Published Version: http://dx.doi.org/10.1016/j.athoracsur.2006.09.024
Status: Published
Publisher: Elsevier Science B.V., Amsterdam.
Identification Number: 10.1016/j.athoracsur.2006.09.024
URI: http://eprints.whiterose.ac.uk/id/eprint/7569

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