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Comparison of cerebral embolization during off-pump and on-pump coronary artery bypass surgery
Christian Lund1, Per K Hol, Runar Lundblad
1Department of Neurology, Oslo, Norway. christian.lund@rikshospitalet.no
Insights
Off-pump surgery significantly reduces brain microembolization during coronary artery bypass grafting. However, this study did not find a significant difference in cognitive outcomes or brain lesions between off-pump and on-pump procedures.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Technology
Background:
- Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) poses a risk of perioperative brain injury, including stroke and cognitive impairment.
- Off-pump CABG (OPCAB) avoids CPB and minimizes aortic instrumentation, potentially reducing brain injury risks.
Purpose of the Study:
- To evaluate whether OPCAB surgery reduces intraoperative cerebral microembolization compared to traditional on-pump CABG.
- To assess the impact of OPCAB on postoperative cognitive function and brain lesions.
Main Methods:
- A prospective, randomized study involving 52 patients undergoing CABG.
- Cerebral microembolization was monitored using transcranial Doppler ultrasound during surgery.
- Preoperative and postoperative cognitive assessments and cerebral MRI were performed.
Main Results:
- Off-pump surgery demonstrated a significant reduction in cerebral microemboli compared to on-pump surgery (16.3 vs. 90.0, p < 0.0001).
- No significant differences were observed in neuropsychological performance or MRI findings at 3 months post-surgery.
- The number of cerebral microemboli did not correlate with cognitive outcomes.
Conclusions:
- Off-pump CABG significantly reduces intraoperative cerebral microembolization.
- In this small patient cohort, a significant reduction in cognitive decline or ischemic brain lesions with OPCAB could not be demonstrated.
Background:
Coronary artery bypass surgery with cardiopulmonary bypass carries a significant risk of perioperative brain injury. At least 1% to 5% will suffer a stroke, and at 3-months postoperatively approximately 30% are reported to have cognitive impairment assessed by neuropsychologic testing. In off-pump surgery cardiopulmonary bypass is not used and instrumentation on the ascending aorta is reduced. The main aim of this study was to assess if off-pump surgery reduces intraoperative cerebral embolization.
Methods:
This was a prospective and randomized study of two comparable groups with regard to age, sex, years of education, preoperative cognitive functioning, and surgical characteristics. Fifty-two patients (29 off-pump) were monitored by the use of transcranial Doppler ultrasound for cerebral microembolization during surgery. Preoperative and postoperative clinical, cerebral magnetic resonance imaging, and neuropsychologic examinations were also carried out.
Results:
There was a significant reduction in the number of cerebral microemboli during off-pump compared with on-pump surgery (16.3 [range 0 to 131] versus 90.0 [range 15 to 274], p < 0.0001). No significant difference with regard to the incidence of neuropsychologic performance (decline in 29% off-pump, 35% on-pump) or neuroradiologic findings at 3 months was found, and there was no association between the number of cerebral microemboli and cognitive outcome.
Conclusions:
This study clearly demonstrates that off-pump surgery leads to a reduction in intraoperative cerebral microembolization. A significant reduction in the number of off-pump patients with cognitive decline or ischemic brain lesions on cerebral magnetic resonance imaging could not be demonstrated in this relatively small patient population.