Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: prospective randomised controlled trial

doi:10.1136/bmj.325.7375.1268

BMJ 2002;325:1268 ( 30 November )

Papers

Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: prospective randomised controlled trial

Editorial by Taggart

Vipin Zamvar, consultant surgeon, ^a David Williams, specialist registrar, ^b Judith Hall, senior lecturer, ^b Nicola Payne, biostatistician, ^c Clare Cann, research nurse, ^b Karen Young, clinical scientist, ^d S Karthikeyan, specialist registrar, ^b John Dunne, consultant anaesthetist. ^b

^a Department of Cardiac Surgery, University Hospital of Wales, Cardiff CF14 4XW, ^b Department of Anaesthesiology, University Hospital of Wales, ^c Medical Data Research Centre, Providence Health System, Portland, OR 97225, USA, ^d Department of Immunology, UK National External Quality Assurance Scheme, Sheffield S5 7YT

Correspondence to: Mr V Zamvar Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW zamvarv{at}hotmail.com

Objective: To assess neurocognitive impairment afterthe off-pump and on-pump techniques for coronary artery bypassgraft surgery in patients with triple vesseldisease.
Design: Randomised controlledtrial.
Setting: University Hospital of Wales,Cardiff.
Participants: 60 patients undergoing coronary artery bypassgraft surgery for triple vessel disease prospectively randomisedto the off-pump or on-pumptechnique.
Main outcome measures: Change in scores in nine standard neuropsychometrictests administered preoperatively and at 1 and 10 weekspostoperatively.
Results: The on-pump group showed a significantly greaterdeterioration in scores for two and three tests at 1 week and10 weeks postoperatively, respectively, than the off-pump group.The on-pump group also showed a significantly higher incidenceof major deterioration in one of the tests both 1 week and 10weeks postoperatively. The incidence of neurocognitive impairmentat 1 week postoperatively was 27% (8 out of 30) in the off-pumpgroup and 63% (19 out of 30) in the on-pump group (P=0.004); andat 10 weeks postoperatively was 10% (3 out of 30) in the off-pumpgroup and 40% (12 out of 30) in the on-pump group (P=0.017).
Conclusion: Off-pump coronary artery bypass graft surgeryresults in less neurocognitive impairment than the on-pumptechnique.

What is already known on this topic
Neurocognitive impairment after coronary artery bypass graft surgery occurs in a major proportion of patients

Cardiopulmonary bypass has been implicated, but the evidence is inconclusive

What this study adds
Off-pump coronary artery bypass graft surgery results in less neurocognitive impairment than the on-pump technique

© BMJ 2002

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

StumbleUpon Add to Technorati

Technorati What's this?

Relevant Articles

Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial: Sharif Al-Ruzzeh, Shane George, Mahmoud Bustami, Jo Wray, Charles Ilsley, Thanos Athanasiou, and Mohamed Amrani
BMJ 2006 332: 1365. [Abstract] [Full Text] [PDF]

Off-pump heart surgery causes less neurocognitive impairment
BMJ 2002 325: 0. [Full Text]

About impaired minds and closed hearts: David Taggart
BMJ 2002 325: 1255-1256. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Shroyer, A. L., Grover, F. L., Hattler, B., Collins, J. F., McDonald, G. O., Kozora, E., Lucke, J. C., Baltz, J. H., Novitzky, D., the Veterans Affairs Randomized On/Off Bypass (ROO, (2009). On-Pump versus Off-Pump Coronary-Artery Bypass Surgery. NEJM 361: 1827-1837 [Abstract] [Full text]
Abu-Omar, Y., Taggart, D. P. (2009). The present status of off-pump coronary artery bypass grafting. Eur. J. Cardiothorac. Surg. 36: 312-321 [Abstract] [Full text]
Anselmi, A., Possati, G., Gaudino, M. (2009). Postoperative inflammatory reaction and atrial fibrillation: simple correlation or causation?. Ann. Thorac. Surg. 88: 326-333 [Abstract] [Full text]
Moller, C. H., Penninga, L., Wetterslev, J., Steinbruchel, D. A., Gluud, C. (2008). Clinical outcomes in randomized trials of off- vs. on-pump coronary artery bypass surgery: systematic review with meta-analyses and trial sequential analyses. Eur Heart J 29: 2601-2616 [Abstract] [Full text]
Takagi, H., Kawai, N., Umemoto, T. (2008). Neurocognitive Decline After Off-Pump Versus On-Pump Coronary Artery Bypass. Ann. Thorac. Surg. 86: 690-690 [Full text]
Stroobant, N., van Nooten, G., De Bacquer, D., Van Belleghem, Y., Vingerhoets, G. (2008). Neuropsychological functioning 3-5 years after coronary artery bypass grafting: does the pump make a difference?. Eur. J. Cardiothorac. Surg. 34: 396-401 [Abstract] [Full text]
Marasco, S. F., Sharwood, L. N., Abramson, M. J. (2008). No improvement in neurocognitive outcomes after off-pump versus on-pump coronary revascularisation: a meta-analysis. Eur. J. Cardiothorac. Surg. 33: 961-970 [Abstract] [Full text]
Motallebzadeh, R., Jahangiri, M. (2008). Meta-analysis of randomized controlled trials of cognitive decline after on-pump versus off-pump coronary artery bypass graft surgery.. J. Thorac. Cardiovasc. Surg. 135: 1400-1401 [Full text]
Briffa, N. (2008). Off pump coronary artery bypass: a passing fad or ready for prime time?. Eur Heart J 29: 1346-1349 [Abstract] [Full text]
Raja, S. G, Dreyfus, G. D (2008). Current Status of Off-pump Coronary Artery Bypass Surgery. Asian Cardiovasc. Thorac. Ann. 16: 164-178 [Abstract] [Full text]
Dewey, T. M., Mack, M. J. (2008). Myocardial Revascularization without Cardiopulmonary Bypass. Card Surg Adult 3: 633-654 [Full text]
Falk, V., Mohr, F. W. (2008). Minimally Invasive Myocardial Revascularization. Card Surg Adult 3: 697-710 [Full text]
Alston, R. P., Kumar, R. A., Cann, C., Hall, J., Sudheer, P., Wilkes, A. (2007). IL-18 and SC5b-9 for predicting neurocognitive dysfunction after cardiopulmonary bypass. Br J Anaesth 99: 444-445 [Full text]
Takagi, H., Tanabashi, T., Kawai, N., Umemoto, T. (2007). Cognitive decline after off-pump versus on-pump coronary artery bypass graft surgery: Meta-analysis of randomized controlled trials. J. Thorac. Cardiovasc. Surg. 134: 512-513 [Full text]
Kumar, R. A., Cann, C., Hall, J. E., Sudheer, P. S., Wilkes, A. R. (2007). Predictive value of IL-18 and SC5b-9 for neurocognitive dysfunction after cardiopulmonary bypass. Br J Anaesth 98: 317-322 [Abstract] [Full text]
Burgess, D. C., Kilborn, M. J., Keech, A. C. (2006). Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur Heart J 27: 2846-2857 [Abstract] [Full text]
Sedrakyan, A., Wu, A. W., Parashar, A., Bass, E. B., Treasure, T. (2006). Off-Pump Surgery Is Associated With Reduced Occurrence of Stroke and Other Morbidity as Compared With Traditional Coronary Artery Bypass Grafting: A Meta-Analysis of Systematically Reviewed Trials * Supplemental Appendix I. Stroke 37: 2759-2769 [Full text]
Dupuis, G., Kennedy, E., Lindquist, R., Barton, F. B., Terrin, M. L., Hoogwerf, B. J., Czajkowski, S. M., Herd, J. A., for the Post CABG Biobehavioral Study Investigator, (2006). Coronary artery bypass graft surgery and cognitive performance.. Am J Crit Care 15: 471-478 [Abstract] [Full text]
Vedin, J., Nyman, H., Ericsson, A., Hylander, S., Vaage, J. (2006). Cognitive function after on or off pump coronary artery bypass grafting.. Eur. J. Cardiothorac. Surg. 30: 305-310 [Abstract] [Full text]
Jensen, B. O., Hughes, P., Rasmussen, L. S., Pedersen, P. U., Steinbruchel, D. A. (2006). Cognitive Outcomes in Elderly High-Risk Patients After Off-Pump Versus Conventional Coronary Artery Bypass Grafting: A Randomized Trial. Circulation 113: 2790-2795 [Abstract] [Full text]
Al-Ruzzeh, S., George, S., Bustami, M., Wray, J., Ilsley, C., Athanasiou, T., Amrani, M. (2006). Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. BMJ 332: 1365- [Abstract] [Full text]
Djaiani, G. N. (2006). Aortic arch atheroma: stroke reduction in cardiac surgical patients.. SEMIN CARDIOTHORAC VASC ANESTH 10: 143-157 [Abstract]
Lingaas, P. S., Hol, P. K., Lundblad, R., Rein, K. A., Mathisen, L., Smith, H.-J., Andersen, R., Thaulow, E., Tonnesen, T. I., Svennevig, J. L., Hauge, S. N., Fredriksen, P. M., Andersen, M., Fosse, E. (2006). Clinical and Radiologic Outcome of Off-Pump Coronary Surgery at 12 Months Follow-Up: A Prospective Randomized Trial. Ann. Thorac. Surg. 81: 2089-2095 [Abstract] [Full text]
Lewis, M. S., Maruff, P., Silbert, B. S., Evered, L. A., Scott, D. A. (2006). Detection of Postoperative Cognitive Decline After Coronary Artery Bypass Graft Surgery is Affected by the Number of Neuropsychological Tests in the Assessment Battery. Ann. Thorac. Surg. 81: 2097-2104 [Abstract] [Full text]
Ernest, C. S., Worcester, M. U.C., Tatoulis, J., Elliott, P. C., Murphy, B. M., Higgins, R. O., Le Grande, M. R., Goble, A. J. (2006). Neurocognitive Outcomes in Off-Pump Versus On-Pump Bypass Surgery: A Randomized Controlled Trial. Ann. Thorac. Surg. 81: 2105-2114 [Abstract] [Full text]
Sendelbach, S., Lindquist, R., Watanuki, S., Savik, K. (2006). Correlates of Neurocognitive Function of Patients After Off-Pump Coronary Artery Bypass Surgery. Am J Crit Care 15: 290-298 [Abstract] [Full text]
Brown, J. M., Poston, R. S., Gammie, J. S., Cardarelli, M. G., Schwartz, K., Sikora, J. A. H., Yi, S., Pierson, R. N. III, Griffith, B. P. (2006). Off-Pump Versus On-Pump Coronary Artery Bypass Grafting in Consecutive Patients: Decision-Making Algorithm and Outcomes. Ann. Thorac. Surg. 81: 555-561 [Abstract] [Full text]
Lund, C., Sundet, K., Tennoe, B., Hol, P. K., Rein, K. A., Fosse, E., Russell, D. (2005). Cerebral Ischemic Injury and Cognitive Impairment After Off-Pump and On-Pump Coronary Artery Bypass Grafting Surgery. Ann. Thorac. Surg. 80: 2126-2131 [Abstract] [Full text]
Alex, J., Laden, G., Cale, A. R.J., Bennett, S., Flowers, K., Madden, L., Gardiner, E., McCollum, P. T., Griffin, S. C. (2005). Pretreatment with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response after cardiopulmonary bypass: A prospective randomized double-blind trial. J. Thorac. Cardiovasc. Surg. 130: 1623-1630 [Abstract] [Full text]
Wijeysundera, D. N., Beattie, W. S., Djaiani, G., Rao, V., Borger, M. A., Karkouti, K., Cusimano, R. J. (2005). Off-Pump Coronary Artery Surgery for Reducing Mortality and Morbidity: Meta-Analysis of Randomized and Observational Studies. J Am Coll Cardiol 46: 872-882 [Abstract] [Full text]
Caus, T., Seree, Y., Marin, P., Khairi, M., Bakkali, A., Guillen, J. C., Bonnet, J. L., Metras, D. (2005). Off-pump coronary surgery in selected patients: better early outcome but more recurrence of angina?. ICVTS 4: 322-326 [Abstract] [Full text]
Keenan, T. D.L., Abu-Omar, Y., Taggart, D. P. (2005). Bypassing the Pump: Changing Practices in Coronary Artery Surgery. Chest 128: 363-369 [Abstract] [Full text]
Alston, R. P. (2005). Pumphead--or not! Does avoiding cardiopulmonary bypass for coronary artery bypass surgery result in less brain damage?. Br J Anaesth 94: 699-701 [Full text]
Carrascal, Y., Casquero, E., Gualis, J., Di Stefano, S., Florez, S., Fulquet, E., Echevarria, J. R., Fiz, L. (2005). Cognitive decline after cardiac surgery: proposal for easy measurement with a new test. ICVTS 4: 216-221 [Abstract] [Full text]
Bainbridge, D., Martin, J., Cheng, D. (2005). Off Pump Coronary Artery Bypass Graft Surgery Versus Conventional Coronary Artery Bypass Graft Surgery: A Systematic Review of the Literature. SEMIN CARDIOTHORAC VASC ANESTH 9: 105-111 [Abstract]
Murphy, G. J, Ascione, R., Angelini, G. D (2004). Coronary artery bypass grafting on the beating heart: surgical revascularization for the next decade?. Eur Heart J 25: 2077-2085 [Abstract] [Full text]
Athanasiou, T., Aziz, O., Mangoush, O., Al-Ruzzeh, S., Nair, S., Malinovski, V., Casula, R., Glenville, B. (2004). Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited. Eur. J. Cardiothorac. Surg. 26: 701-710 [Abstract] [Full text]
Abu-Omar, Y., Cifelli, A., Matthews, P. M., Taggart, D. P. (2004). The role of microembolisation in cerebral injury as defined by functional magnetic resonance imaging. Eur. J. Cardiothorac. Surg. 26: 586-591 [Abstract] [Full text]
van der Heijden, G. J.M.G., Nathoe, H. M., Jansen, E. W.L., Grobbee, D. E. (2004). Meta-analysis on the effect of off-pump coronary bypass surgery. Eur. J. Cardiothorac. Surg. 26: 81-84 [Abstract] [Full text]
Abu-Omar, Y., Balacumaraswami, L., Pigott, D. W., Matthews, P. M., Taggart, D. P. (2004). Solid and gaseous cerebral microembolization during off-pump, on-pump, and open cardiac surgery procedures. J. Thorac. Cardiovasc. Surg. 127: 1759-1765 [Abstract] [Full text]
Sergeant, P., Wouters, P., Meyns, B., Bert, C., Van Hemelrijck, J., Bogaerts, C., Sergeant, G., Slabbaert, K. (2004). OPCAB versus early mortality and morbidity: an issue between clinical relevance and statistical significance. Eur. J. Cardiothorac. Surg. 25: 779-785 [Abstract] [Full text]
Puskas, J. D., Williams, W. H., Mahoney, E. M., Huber, P. R., Block, P. C., Duke, P. G., Staples, J. R., Glas, K. E., Marshall, J. J., Leimbach, M. E., McCall, S. A., Petersen, R. J., Bailey, D. E., Weintraub, W. S., Guyton, R. A. (2004). Off-Pump vs Conventional Coronary Artery Bypass Grafting: Early and 1-Year Graft Patency, Cost, and Quality-of-Life Outcomes: A Randomized Trial. JAMA 291: 1841-1849 [Abstract] [Full text]
van Dijk, D, Moons, K G M, Keizer, A M A, Jansen, E W L, Hijman, R, Diephuis, J C, Borst, C, de Jaegere, P P T, Grobbee, D E, Kalkman, C J (2004). Association between early and three month cognitive outcome after off-pump and on-pump coronary bypass surgery. Heart 90: 431-434 [Abstract] [Full text]
Verma, S., Fedak, P. W.M., Weisel, R. D., Szmitko, P. E., Badiwala, M. V., Bonneau, D., Latter, D., Errett, L., LeClerc, Y. (2004). Off-Pump Coronary Artery Bypass Surgery: Fundamentals for the Clinical Cardiologist. Circulation 109: 1206-1211 [Full text]
Legare, J.-F., Buth, K. J., King, S., Wood, J., Sullivan, J. A., Friesen, C. H., Lee, J., Stewart, K., Hirsch, G. M. (2004). Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump. Circulation 109: 887-892 [Abstract] [Full text]
Taggart, D. (2004). Off-pump surgery and cerebral injury. J. Thorac. Cardiovasc. Surg. 127: 7-9 [Full text]
Bucerius, J., Gummert, J. F., Borger, M. A., Walther, T., Doll, N., Falk, V., Schmitt, D. V., Mohr, F. W. (2004). Predictors of delirium after cardiac surgery delirium: Effect of beating-heart (off-pump) surgery. J. Thorac. Cardiovasc. Surg. 127: 57-64 [Abstract] [Full text]
Pocar, M., Donatelli, F. (2004). Abdominal tumors with cavoatrial extension. J. Thorac. Cardiovasc. Surg. 127: 301-302 [Full text]
Reston, J. T., Tregear, S. J., Turkelson, C. M. (2003). Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting. Ann. Thorac. Surg. 76: 1510-1515 [Abstract] [Full text]
Ngaage, D. L. (2003). Off-pump coronary artery bypass grafting: the myth, the logic and the science. Eur. J. Cardiothorac. Surg. 24: 557-570 [Abstract] [Full text]
Malik, I. (2003). JournalScan. Heart 89: 239-240 [Full text]
(2003). Cognitive Impairment After CABG Depends on Whether Bypass Is Used. JWatch General 2003: 3-3 [Full text]
Taggart, D. (2002). About impaired minds and closed hearts. BMJ 325: 1255-1256 [Full text]

Rapid Responses:

Read all Rapid Responses

Brain damage after cardiac surgery: Bryan Jennett, et al.
bmj.com, 5 Dec 2002 [Full text]
Cognitive impairment, operative time, and elderly people: Lorenzo Marchini
bmj.com, 7 Dec 2002 [Full text]
Cardiopulmonary bypass may not be so bad: Donald C Whitaker
bmj.com, 16 Jan 2003 [Full text]
Re: alpha stat vs pH stat during cardiopulmonary bypass: Richard G Fiddian-Green
bmj.com, 18 Jan 2003 [Full text]
Cardiac Surgery and Cognitive Impairment - about closed minds and impaired hearts: Anne-Marie O'Dwyer, et al.
bmj.com, 21 Feb 2003 [Full text]
Should the target in the pH-stat protocol be a lower pH?: Richard G Fiddian-Green
bmj.com, 4 Mar 2004 [Full text]