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The Octopus II stabilizing system: biochemical and neuropsychological outcomes in coronary artery bypass surgery
R A Baker1, M J Andrew, I K Ross
1Cardiac Surgical Research Group, Department of Cardiothoracic Surgery, Division of Medicine, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia. Rob.Baker@flinders.edu.au
Insights
Off-pump coronary artery bypass graft (CABG) surgery using the Octopus II system showed reduced Troponin T release, suggesting myocardial protection. However, no significant neuropsychological benefits were observed compared to traditional CABG with cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Neurological Outcomes in Cardiac Surgery
Background:
- Traditional coronary artery bypass graft (CABG) surgery uses cardiopulmonary bypass (CPB).
- Off-pump coronary artery bypass (OPCAB) surgery aims to reduce CPB-related complications.
- The Octopus II stabilizing system facilitates OPCAB.
Purpose of the Study:
- To compare myocardial and cerebral protection between OPCAB with Octopus II and traditional CABG with CPB.
- To evaluate Troponin T release as a marker of myocardial injury.
- To assess neuropsychological function after both surgical procedures.
Main Methods:
- Randomized trial of elective patients with double or triple vessel disease.
- Groups: Conventional CABG with CPB (n=14) vs. OPCAB with Octopus II (n=12).
- Measured Troponin T (TnT) and performed neuropsychological assessments at multiple time points.
Main Results:
- Significantly reduced Troponin T release in OPCAB patients at 8, 10, and 12 hours (p=0.033, 0.038, 0.019).
- No significant differences in composite clinical endpoints, infarction, or intubation time.
- Neuropsychological deficit incidence was similar between groups at 7-day and 6-month follow-ups.
Conclusions:
- Reduced TnT release indicates a potential myocardial benefit of OPCAB using the Octopus II system.
- Neuropsychological benefits of OPCAB with Octopus II require further investigation.
- OPCAB with Octopus II may offer myocardial protection comparable to traditional CABG.
Introduction:
The aim of this study was to determine if coronary artery bypass graft (CABG) surgery performed utilizing the Octopus II stabilizing system provides myocardial and cerebral protection comparable to traditional CABG surgery utilizing cardiopulmonary bypass (CPB).
Methods:
Elective patients requiring surgery for double or triple vessel disease were randomized to receive either conventional CABG with CPB (n = 14) or OPCAB using the Octopus II stabilizing system (n = 12), after receiving institutional approval and written consent. Exclusion criteria included previous cardiac surgery, recent myocardial infarction, and previous cerebrovascular disease. Troponin T (TnT) was measured preoperatively and at 2, 4, 6, 8, 10, 12, 24, and 72 hours after initiation of grafting. Neuropsychological assessments (10 measures) were performed in the week prior to surgery, one week, and six months after surgery.
Results:
Troponin T release was reduced in the OPCAB patients at all time points (repeated measures ANOVA p = 0.043), reaching significance at 8, 10 and 12 hours (p = 0.033, 0.038, 0.019). Other factors (composite clinical end point (prolonged LOS or ICU stay or 30-day mortality), infarction, and intubation time) did not show any significant differences between the two groups. The incidence of neuropsychological deficits was not different between the two groups at both seven-day and six-month follow-up assessments.
Conclusions:
Decreased TnT release suggests a myocardial benefit for the OPCAB procedure. A neuropsychological benefit remains to be demonstrated.
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