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 undergoingnonemergent 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.
RCT Entities:
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.
Authors: Ozioma C Okonkwo; Ronald A Cohen; John Gunstad; Geoffrey Tremont; Michael L Alosco; Athena Poppas Journal: Cerebrovasc Dis Date: 2010-08-05 Impact factor: 2.762
Authors: J L Rudolph; K A Schreiber; D J Culley; R E McGlinchey; G Crosby; S Levitsky; E R Marcantonio Journal: Acta Anaesthesiol Scand Date: 2010-04-15 Impact factor: 2.105