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Neurological outcomes in coronary surgery: independent effect of avoiding cardiopulmonary bypass
Nirav C Patel1, Anand P Deodhar, Antony D Grayson
1Department of Cardiothoracic Surgery, The Cardiothoracic Centre-Liverpool, United Kingdom.
Insights
Off-pump coronary artery bypass grafting (CABG) reduces neurologic deficits compared to on-pump procedures. Avoiding cardiopulmonary bypass (CPB) is key, while aortic manipulation had no significant impact on outcomes.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Anesthesiology
Background:
- Inconsistent findings exist regarding neuroprotective effects of off-pump coronary artery bypass grafting (CABG).
- This study quantifies the independent impact of avoiding cardiopulmonary bypass (CPB) and aortic manipulation on neurologic outcomes post-CABG.
Purpose of the Study:
- To determine the independent effects of cardiopulmonary bypass (CPB) avoidance and aortic manipulation on neurologic outcomes in CABG patients.
- To compare neurologic outcomes across on-pump CABG, off-pump CABG with aortic manipulation, and off-pump CABG without aortic manipulation.
Main Methods:
- A retrospective analysis of 2,327 isolated CABG cases (April 1997-May 2001) from two institutions.
- Patients were categorized into three groups: on-pump CPB, off-pump with aortic manipulation, and off-pump without aortic manipulation.
- Multivariate logistic regression controlled for covariates including age, sex, comorbidities, and ejection fraction.
Main Results:
- Incidence of focal neurologic deficit was 1.6% (on-pump), 0.4% (off-pump with manipulation), and 0.5% (off-pump without manipulation).
- Cardiopulmonary bypass (CPB) use was a significant risk factor for focal neurologic deficit (OR 3.82, p=0.005).
- Aortic manipulation did not significantly affect neurologic outcomes in off-pump procedures.
Conclusions:
- Off-pump CABG, irrespective of aortic manipulation, is associated with reduced adverse neurologic outcomes compared to on-pump procedures.
- Avoiding CPB is the primary factor contributing to improved neurologic outcomes in off-pump CABG.
Background:
Recent studies examining neuroprotective effects of off-pump coronary artery bypass grafting (CABG) have shown inconsistent results. We examined our database to quantify the independent effects of avoidance of cardiopulmonary bypass (CPB) and aortic manipulation on neurologic outcomes after CABG.
Methods:
A total of 2,327 consecutive cases undergoing isolated CABG between April 1997 and May 2001 were identified at our two institutions. Patients were divided into three groups: on CPB, off-pump with aortic manipulation, and off-pump without aortic manipulation. To control for the confounding effects of other risk factors, we performed a multivariate logistic regression analysis. Potential covariates considered in the logistic model included age, sex, redo operations, diabetes, chronic obstructive pulmonary disease, neurologic disease, peripheral vascular disease, ejection fraction, and priority of operation.
Results:
A total of 1,210 cases were performed on CPB, compared with 520 off-pump with aortic manipulation, and 597 off-pump without aortic manipulation. The incidence of focal neurologic deficit was 1.6% (n = 19) in the on-pump group, 0.4% (n = 2) in the off-pump with aortic manipulation group, and 0.5% (n = 3) for the off-pump without aortic manipulation group (p for trend = 0.027). The results of the multivariate logistic regression analysis demonstrated that use of CPB was a risk factor for focal neurologic deficit, with an odds ratio of 3.82 (95% confidence interval, 1.41 to 10.34; p = 0.005). Aortic manipulation did not significantly influence neurologic outcome in off-pump patients.
Conclusions:
Off-pump operation, with or without aortic manipulation, reduces adverse neurologic outcomes compared with on-pump procedures.