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Neurological outcomes after on-pump vs off-pump CABG in patients with cerebrovascular disease

Carmelo Dominici1, Antonio Salsano2, Antonio Nenna1

  • 1Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.

Journal of Cardiac Surgery
|July 4, 2019
PubMed

Insights

Off-pump coronary artery bypass graft (CABG) surgery significantly reduces the risk of stroke and delirium in patients with a history of cerebrovascular disease. This approach offers enhanced neurological safety compared to traditional on-pump CABG.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Medical Technology

Background:

  • Patients with a history of cerebrovascular disease are at higher risk for neurological complications after coronary artery bypass graft (CABG) surgery.
  • Off-pump CABG (OPCAB) is hypothesized to offer neuroprotective benefits in these high-risk individuals.

Purpose of the Study:

  • To investigate the impact of OPCAB versus on-pump CABG on postoperative neurologic events.
  • To assess the incidence of stroke, delirium, and Major Adverse Neurological Events (MANE) in patients with prior transient ischemic attack (TIA) or stroke.

Main Methods:

  • Retrospective analysis of 414 patients undergoing isolated CABG between January 2015 and September 2018.
  • Comparison of neurological outcomes between 295 patients who had on-pump CABG and 119 patients who had OPCAB.
  • Propensity score (PS) adjusted analysis was employed to control for confounding factors.

Main Results:

  • OPCAB was associated with a significantly lower incidence of postoperative stroke (3.4% vs 9.8%, P=.046).
  • Postoperative delirium was more frequent in the on-pump group (11.5% vs 4.2%, P=.034).
  • The composite endpoint of MANE was significantly lower in the OPCAB group (7.6% vs 20.3%, P=.003).

Conclusions:

  • Off-pump CABG is associated with reduced risks of stroke, delirium, and overall adverse neurological events in patients with a history of TIA or stroke.
  • OPCAB may be a safer surgical option for patients with high neurological risk undergoing CABG.
Abstract

Keywords:
deliriummyocardial revascularizationoff-pumpstroke

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