Cerebral perfusion during off-pump coronary artery bypass grafting

It is still unclear whether cerebral perfusion is affected during off-pump coronary bypass grafting (OPCABG). We investigated the predictive value of the neurobiochemical markers of brain damage and cerebral perfusion in relation to early neuropsychological outcome after OPCABG.

We performed OPCABG in ten patients (mean age, 63.4 +/- 5.5 years). A 5.5 F oximetric catheter was placed in the jugular bulb to continuously measure jugular oxygen saturation (SjO(2)) during OPCABG. We also examined the activity of daily living (ADL) index and performed the Mini-Mental State Examination (MMSE) to assess neuropsychological state preoperatively and 7 days postoperatively. Venous serum levels of neuron-specific enolase (NSE) and brain-specific creatine kinase (CK-BB) were measured preoperatively and 24 h after skin closure.

The mean arterial blood pressure and the SjO(2) during anastomosis of the left circumflex coronary artery (Cx) were significantly lower than that of the left anterior descending coronary artery (LAD) (P < 0.001). None of the patients died. There was no transient or permanent neurologic deficit. Cognitive decline was evident in two patients with a low SjO(2) and a high postoperative NSE level. The postoperative CK-BB value was normal in all patients.

Monitoring intraoperative continuous cerebral oxygen desaturation and postoperative NSE levels could be useful for predicting early neuropsychological outcome after OPCABG.