[Postoperative cognitive dysfunction in off-pump versus on-pump coronary artery bypass surgery]

Area of Science:

• Neurology and Cardiovascular Surgery
• Geriatric Medicine
• Neuroscience

Context:

• Patients undergoing coronary artery bypass grafting (CABG) are increasingly older with extensive vascular disease.
• Undiagnosed cerebral small vessel diseases (SVD) and dementia are prevalent in this population.
• Postoperative cognitive dysfunction (POCD) is a significant concern following CABG.

Purpose:

• To explore the incidence and contributing factors of POCD in elderly CABG patients.
• To evaluate the efficacy of off-pump CABG versus conventional CABG in mitigating POCD.
• To investigate the role of patient-related factors, such as SVD and mild cognitive impairment, in POCD.

Summary:

• POCD is multifactorial, linked to cardiopulmonary bypass, cerebral emboli, hypoperfusion, and inflammation.
• While off-pump CABG was proposed to reduce POCD, studies show mixed results.
• Focus is shifting towards patient-specific factors, including SVD and dementia, as key contributors to POCD.

Impact:

• Preoperative cerebrovascular evaluation (MRI, MRA, ultrasound) and cognitive screening can identify high-risk patients.
• Individualizing surgical approaches based on preoperative assessments may help reduce POCD incidence.
• This approach aims to improve cognitive outcomes in elderly patients undergoing major cardiac surgery.