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Brain damage and cardiopulmonary bypass: is there really any association?
1Department of Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh, UK. peter.alston@ed.ac.uk
Insights
Cardiopulmonary bypass (CPB) may not cause brain damage after heart surgery. Evidence suggests stroke and cognitive deficits are similar in on-pump and off-pump coronary artery bypass grafting (CABG) procedures.
Area of Science:
- Cardiology
- Neurology
- Surgical Outcomes
Background:
- Brain damage, including stroke and cognitive deficits, is often attributed to cardiopulmonary bypass (CPB) during heart surgery.
- This belief has been widely accepted without rigorous examination of comparative surgical techniques.
Purpose of the Study:
- To critically evaluate the evidence linking cardiopulmonary bypass (CPB) to brain damage after heart surgery.
- To compare the incidence of stroke and cognitive deficits in patients undergoing on-pump versus off-pump coronary artery bypass grafting (CABG).
Main Methods:
- Systematic review of randomized control trials (RCTs), systematic reviews, and meta-analyses.
- Studies included focused on coronary artery bypass grafting (CABG) comparing on-pump and off-pump procedures.
- Outcomes assessed were stroke incidence and cognitive function.
Main Results:
- Current evidence does not definitively prove CPB causes brain damage.
- The incidence of stroke and impact on cognition appear similar between on-pump and off-pump CABG.
- Findings challenge the long-held assumption that CPB is the primary cause of neurological deficits.
Conclusions:
- Cardiopulmonary bypass (CPB) may not be the sole or primary cause of brain damage post-heart surgery.
- Further research is warranted, but current data suggest neurological outcomes are comparable regardless of CPB use in CABG.
- This review questions established dogma regarding CPB and neurological injury.
Abstract:
Brain damage, in the form of stroke and cognitive deficit associated with heart surgery, has long been attributed unquestioningly to cardiopulmonary bypass (CPB). The aim of this paper is to review the randomised control trials (RCT), systematic reviews and meta-analyses of studies, comparing patients who have undergone on- or off-pump coronary artery bypass grafting (CABG) surgeries that have used stroke or cognition as an outcome to determine whether CPB is associated with brain damage. Although not definitive, the evidence base to date strongly suggests that the incidence of stroke and the effect on cognition, if any, are no different whether CABG surgery is undertaken on- or off-pump. In addition and contrary to long-held beliefs, this review leads to the conclusion that CPB may well not be the cause of the brain damage associated with heart surgery.
