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Published on: March 27, 2018
Neurocognitive impairment after off-pump and on-pump coronary artery bypass graft surgery - an Iranian experience
Mehdi Farhoudi1, Kaveh Mehrvar, Abbas Afrasiabi
1Neurosciences Research Center, Imam Reza Hospital.
Insights
Coronary artery bypass graft (CABG) surgery on-pump versus off-pump techniques showed no significant difference in neurocognitive outcomes 2 months post-operation for low-risk patients. Both methods resulted in similar rates of cognitive impairment.
Area of Science:
- Cardiovascular Surgery
- Neuroscience
- Medical Technology
Background:
- Coronary artery bypass graft (CABG) is a common surgery with potential for postoperative neurocognitive impairment.
- The impact of on-pump versus off-pump techniques on cognitive function remains debated.
Purpose of the Study:
- To compare the effects of on-pump and off-pump CABG techniques on neurocognitive impairment in low-risk patients.
Main Methods:
- 201 low-risk CABG patients (left-ventricular ejection fraction >30%, no arrhythmia) were enrolled.
- Neurocognitive function was assessed using the Mini-Mental State Examination (MMSE) before and 2 months after surgery.
- Patients were divided into on-pump and off-pump groups.
Main Results:
- Out of 154 patients, 95 were in the off-pump group and 59 in the on-pump group.
- Two-month postoperative neurocognitive impairment rates were 28.8% for on-pump and 29.4% for off-pump (P=0.54).
- Mean postoperative MMSE scores did not significantly differ between groups (P=0.09).
Conclusions:
- Neither on-pump nor off-pump CABG techniques demonstrated a significant difference in neurocognitive outcomes at 2 months post-procedure for low-risk patients.
- The findings suggest comparable cognitive safety profiles for both surgical approaches in this patient cohort.
Background:
Coronary artery bypass graft (CABG) surgery is one of the most commonly performed surgical procedures worldwide, and it may be accompanied by postoperative neurocognitive impairment. Although this complication has been attributed to the use of cardiopulmonary bypass, it is still a matter of debate whether the switch from on-pump to off-pump technique affects the cognitive function.
Objective:
The aim of this study was to compare the impact of the on-pump and off-pump techniques on neurocognitive impairment in low-risk CABG surgery groups.
Methods:
In a descriptive and analytic study, 201 CABG patients with left-ventricular ejection fraction >30%, and without cardiac arrhythmia were enrolled. Before the elective operation, all patients underwent neurological examination and neurocognitive test, Mini-Mental State Examination (MMSE). Two months following the operation, both on- and off-pump, the patients were re-examined by MMSE to detect any neurocognitive impairment.
Results:
Out of 154 patients included in the study, 95 (61.6%) and 59 (38.3%) patients were in off-pump and on-pump groups, respectively. Mean age of the patients was 57.17 ± 9.82 years. A 2-month postoperative neurocognitive impairment was detected among 17 patients of on-pump group (28.8%) and in 28 cases of off-pump group (29.4%) (P = 0.54). The mean postoperative MMSE scores were not comparable between groups (25.01 ± 4.49 in off-pump group versus 23.73 ± 4.88 in on-pump group, P = 0.09).
Conclusion:
The present study revealed that in low-risk patients undergoing CABG surgery, either the techniques of on-pump or off-pump did not differ regarding the neurocognitive outcome 2 months after the procedure.
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