Björn Stessel1,2, Kristof Nijs1,3, Caroline Pelckmans1, Jeroen Vandenbrande1, Jean-Paul Ory1, Alaaddin Yilmaz4, Pascal Starinieri4, Michiel Van Tornout1, Nina De Klippel5, Paul Dendale2,6. 1. Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium. 2. Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium. 3. Department of Anaesthesiology and Pain Medicine, University Hospital, Leuven, Belgium. 4. Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium. 5. Department of Neurology, Jessa Hospital, Hasselt, Belgium. 6. Department of Cardiology, Jessa Hospital, Hasselt, Belgium.
Abstract
BACKGROUND/ OBJECTIVES: Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimally invasive CABG procedure with retrograde arterial perfusion. The main objective of this study is to assess neurocognitive outcome after Endo-CABG. METHODS/ DESIGN: In this prospective observational cohort study, patients were categorised into: Endo-CABG (n = 60), a comparative Percutaneous Coronary Intervention (PCI) group (n = 60) and a healthy volunteer group (n = 60). A clinical neurological examination was performed both pre- and postoperatively, delirium was assessed postoperatively. A battery of 6 neurocognitive tests, Quality of life (QoL) and the level of depressive feelings were measured at baseline and after 3 months. Patient Satisfaction after Endo-CABG was assessed at 3-month follow-up. Primary endpoints were incidence of postoperative cognitive dysfunction (POCD), stroke and delirium after Endo-CABG. Secondary endpoints were QOL, patient satisfaction and the incidence of depressive feelings after Endo-CABG. RESULTS: In total, 1 patient after Endo-CABG (1.72%) and 1 patient after PCI (1.67%) suffered from stroke during the 3-month follow-up. POCD in a patient is defined as a Reliable Change Index ≤-1.645 or Z-score ≤-1.645 in at least two tests, and was found in respectively 5 and 6 patients 3 months after Endo-CABG and PCI. Total incidence of POCD/stroke was not different (PCI: n= 7 [15.9%]; Endo-CABG: n= 6 [13.0%], p = 0.732). ICU delirium after Endo-CABG was found in 5 (8.6%) patients. QoL increased significantly three months after Endo-CABG and was comparable with QoL level after PCI and in the control group. Patient satisfaction after Endo-CABG and PCI was comparable. At follow-up, the level of depressive feelings was decreased in all groups. CONCLUSIONS: The incidence of poor neurocognitive outcome, including stroke, POCD and postoperative ICU delirium until three months after Endo-CABG is low and comparable with PCI. TRIAL REGISTRATION: Registered on ClinicalTrials.gov (NCT02979782).
BACKGROUND/ OBJECTIVES: Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimally invasive CABG procedure with retrograde arterial perfusion. The main objective of this study is to assess neurocognitive outcome after Endo-CABG. METHODS/ DESIGN: In this prospective observational cohort study, patients were categorised into: Endo-CABG (n = 60), a comparative Percutaneous Coronary Intervention (PCI) group (n = 60) and a healthy volunteer group (n = 60). A clinical neurological examination was performed both pre- and postoperatively, delirium was assessed postoperatively. A battery of 6 neurocognitive tests, Quality of life (QoL) and the level of depressive feelings were measured at baseline and after 3 months. Patient Satisfaction after Endo-CABG was assessed at 3-month follow-up. Primary endpoints were incidence of postoperative cognitive dysfunction (POCD), stroke and delirium after Endo-CABG. Secondary endpoints were QOL, patient satisfaction and the incidence of depressive feelings after Endo-CABG. RESULTS: In total, 1 patient after Endo-CABG (1.72%) and 1 patient after PCI (1.67%) suffered from stroke during the 3-month follow-up. POCD in a patient is defined as a Reliable Change Index ≤-1.645 or Z-score ≤-1.645 in at least two tests, and was found in respectively 5 and 6 patients 3 months after Endo-CABG and PCI. Total incidence of POCD/stroke was not different (PCI: n= 7 [15.9%]; Endo-CABG: n= 6 [13.0%], p = 0.732). ICU delirium after Endo-CABG was found in 5 (8.6%) patients. QoL increased significantly three months after Endo-CABG and was comparable with QoL level after PCI and in the control group. Patient satisfaction after Endo-CABG and PCI was comparable. At follow-up, the level of depressive feelings was decreased in all groups. CONCLUSIONS: The incidence of poor neurocognitive outcome, including stroke, POCD and postoperative ICU delirium until three months after Endo-CABG is low and comparable with PCI. TRIAL REGISTRATION: Registered on ClinicalTrials.gov (NCT02979782).
Authors: A Laurie Shroyer; Frederick L Grover; Brack Hattler; Joseph F Collins; Gerald O McDonald; Elizabeth Kozora; John C Lucke; Janet H Baltz; Dimitri Novitzky Journal: N Engl J Med Date: 2009-11-05 Impact factor: 91.245
Authors: Felix Hernandez; Jeremiah R Brown; Donald S Likosky; Robert A Clough; Anne L Hess; Robert M Roth; Cathy S Ross; Cindy M Whited; Gerald T O'Connor; John D Klemperer Journal: Ann Thorac Surg Date: 2007-12 Impact factor: 4.330
Authors: Anne G Vedel; Frederik Holmgaard; Lars S Rasmussen; Annika Langkilde; Olaf B Paulson; Theis Lange; Carsten Thomsen; Peter Skov Olsen; Hanne Berg Ravn; Jens C Nilsson Journal: Circulation Date: 2018-01-16 Impact factor: 29.690
Authors: Maurice Theunissen; Madelon L Peters; Erik G W Schouten; Audrey A A Fiddelers; Mark G A Willemsen; Patrícia R Pinto; Hans-Fritz Gramke; Marco A E Marcus Journal: PLoS One Date: 2014-06-24 Impact factor: 3.240