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

Reza Motallebzadeh; J. Martin Bland; Hugh S. Markus; Juan Carlos Kaski; Marjan Jahangiri

doi:10.1016/j.athoracsur.2006.09.024

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

Reza Motallebzadeh, J. Martin Bland, Hugh S. Markus, Juan Carlos Kaski, Marjan Jahangiri

Health Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

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 neuro-cognitive 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. (c) 2007 by The Society of Thoracic Surgeons.

Original language	English
Pages (from-to)	475-482
Number of pages	8
Journal	The Annals of Thoracic Surgery
Volume	83
Issue number	2
DOIs	https://doi.org/10.1016/j.athoracsur.2006.09.024
Publication status	Published - Feb 2007

Keywords

CARDIOPULMONARY BYPASS
STATISTICS NOTES
CARDIAC-SURGERY
MICROEMBOLI
OUTCOMES
TRIAL
REVASCULARIZATION
FREQUENCY
CONSENSUS
IMPACT

Access to Document

10.1016/j.athoracsur.2006.09.024

http://dx.doi.org/10.1016/j.athoracsur.2006.09.024

Cite this

@article{f159483fbede4c699db375a5262fc221,

title = "Neurocognitive function and cerebral emboli: Randomized study of on-pump versus off-pump coronary artery bypass surgery",

abstract = "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 neuro-cognitive 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. (c) 2007 by The Society of Thoracic Surgeons.",

keywords = "CARDIOPULMONARY BYPASS, STATISTICS NOTES, CARDIAC-SURGERY, MICROEMBOLI, OUTCOMES, TRIAL, REVASCULARIZATION, FREQUENCY, CONSENSUS, IMPACT",

author = "Reza Motallebzadeh and Bland, {J. Martin} and Markus, {Hugh S.} and Kaski, {Juan Carlos} and Marjan Jahangiri",

year = "2007",

month = feb,

doi = "10.1016/j.athoracsur.2006.09.024",

language = "English",

volume = "83",

pages = "475--482",

journal = "The Annals of Thoracic Surgery",

issn = "0003-4975",

publisher = "Elsevier",

number = "2",

}

TY - JOUR

T1 - Neurocognitive function and cerebral emboli

T2 - Randomized study of on-pump versus off-pump coronary artery bypass surgery

AU - Motallebzadeh, Reza

AU - Bland, J. Martin

AU - Markus, Hugh S.

AU - Kaski, Juan Carlos

AU - Jahangiri, Marjan

PY - 2007/2

Y1 - 2007/2

N2 - 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 neuro-cognitive 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. (c) 2007 by The Society of Thoracic Surgeons.

AB - 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 neuro-cognitive 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. (c) 2007 by The Society of Thoracic Surgeons.

KW - CARDIOPULMONARY BYPASS

KW - STATISTICS NOTES

KW - CARDIAC-SURGERY

KW - MICROEMBOLI

KW - OUTCOMES

KW - TRIAL

KW - REVASCULARIZATION

KW - FREQUENCY

KW - CONSENSUS

KW - IMPACT

U2 - 10.1016/j.athoracsur.2006.09.024

DO - 10.1016/j.athoracsur.2006.09.024

M3 - Article

SN - 0003-4975

VL - 83

SP - 475

EP - 482

JO - The Annals of Thoracic Surgery

JF - The Annals of Thoracic Surgery

IS - 2

ER -