Off-pump coronary artery bypass grafting may be associated with lesser postoperative neurocognitive impairment

Papers p 1268

Coronary artery bypass grafting is highly effective in improving the quality of life for patients with ischaemic heart disease and the life expectancy for certain anatomical patterns of ischaemic heart disease. Consequently, coronary artery bypass grafting is currently perhaps one of the most commonly performed major operations in the industrialised world; more than a million procedures are performed worldwide every year. Unfortunately subtle impairment of cognitive function is common after surgery and may be related to cardiopulmonary bypass at the time of surgery.

Over the past decade advances in anaesthesia, surgery, and perioperative management of patients resulted in mortality of coronary artery bypass grafting remaining at 2-3% despite a marked increase in the risk profile of such procedures. Brain injury is now the most feared complication of coronary artery bypass grafting and occurs in two forms.1 Although clinically overt cerebral injury is infrequent (around 3% of patients have a stroke) subtle impairment of higher cognitive function is common. Detailed cognitive assessment, using a battery of tests, shows some impairment in as many as 80% of patients at the time they are discharged from hospital, which persists in around a quarter of them at six months. 1 2 Recently neurocognitive impairment early after surgery has been shown to correlate with both late decline and impaired measures of quality of life. 3 4 …