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Published on: March 27, 2018
No improvement in neurocognitive outcomes after off-pump versus on-pump coronary revascularisation: a meta-analysis
Silvana F Marasco1, Lisa N Sharwood, Michael J Abramson
1CJOB Cardiothoracic Department, The Alfred Hospital, Commercial Road, Prahran 3181, Victoria, Australia. s.marasco@alfred.org.au
Insights
Off-pump coronary artery bypass grafting (CABG) does not show significant neurocognitive benefits compared to on-pump CABG. This meta-analysis found no convincing differences in cognitive outcomes between the two surgical techniques.
Area of Science:
- Cardiovascular Surgery
- Neuroscience
- Medical Statistics
Background:
- Off-pump coronary artery bypass grafting (CABG) gained popularity due to theoretical advantages like reduced stroke and neurocognitive dysfunction.
- Postoperative stroke rates are low (<1%) for elective CABG, making stroke differences difficult to establish between techniques.
- Neurocognitive function changes are more frequent postoperatively, offering greater potential to demonstrate surgical technique improvements.
Purpose of the Study:
- To evaluate significant differences in neurocognitive outcomes between off-pump and on-pump CABG.
- To conduct a meta-analysis of prospective randomized controlled trials comparing off-pump versus on-pump CABG.
Main Methods:
- A comprehensive database search for randomized controlled trials comparing off-pump and on-pump CABG was performed.
- Eight trials involving 892 patients reporting neurocognitive outcomes met the inclusion criteria.
- Data from seven studies were combined for five neurocognitive tests: Rey Auditory Verbal Learning, Grooved Pegboard, Trail A and B, and Digit Symbol.
Main Results:
- No convincing differences in neurocognitive testing outcomes were observed between the off-pump and on-pump CABG groups.
- Analysis of five standardized neurocognitive tests revealed no significant disparities.
- The meta-analysis did not identify superior neurocognitive performance with either surgical approach.
Conclusions:
- Off-pump CABG does not offer significant neurocognitive benefits over on-pump CABG.
- Current evidence suggests no demonstrable advantage in cognitive function for beating heart surgery compared to conventional CABG.
- Further research may be needed to explore subtle neurocognitive differences or specific patient subgroups.
Abstract:
The popularity of off-pump (beating heart) coronary artery bypass grafting (CABG) was initially stimulated by numerous theoretical benefits including lower incidence of stroke and neurocognitive dysfunction. With a postoperative stroke rate of less than 1% for elective CABG, it has been very difficult to demonstrate any significant differences in this outcome between techniques. However, changes in neurocognitive function are more common in the postoperative setting and thus provide greater power for demonstrating improvement with changes in surgical technique. The aim of this meta-analysis was to assess whether there were significant differences in neurocognitive outcomes in patients after undergoing off-pump versus on-pump CABG. A database search for prospective randomised controlled trials of off-pump versus on-pump CABG in any language was conducted. Eight trials incorporating 892 patients fulfilled all the inclusion criteria for reporting of neurocognitive outcomes, and were able to be included in this meta-analysis. Sufficient data were available across the seven studies to combine results for five neurocognitive tests (Rey Auditory Verbal Learning, Grooved Pegboard, Trail A and B, and Digit Symbol). Overall there were no convincing differences in outcomes in neurocognitive testing between off-pump and on-pump CABG groups. The results of this meta-analysis show that there are no significant neurocognitive benefits when comparing off-pump versus on-pump CABG.
