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Published on: March 27, 2018
Neurological outcome after minimally invasive coronary artery bypass surgery (NOMICS): An observational prospective
Björn Stessel1,2, Kristof Nijs1,3, Caroline Pelckmans1
1Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium.
Insights
Endoscopic coronary artery bypass grafting (Endo-CABG) shows low rates of neurocognitive decline, stroke, and delirium, comparable to Percutaneous Coronary Intervention (PCI). Quality of life and patient satisfaction remain high after Endo-CABG.
Area of Science:
- Cardiovascular Surgery
- Neuroscience
- Minimally Invasive Procedures
Background:
- Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimally invasive surgical technique.
- Assessing neurocognitive outcomes is crucial for evaluating new surgical procedures.
Purpose of the Study:
- To evaluate the neurocognitive outcomes following Endoscopic coronary artery bypass grafting (Endo-CABG).
- To compare neurocognitive function, quality of life, and patient satisfaction after Endo-CABG versus Percutaneous Coronary Intervention (PCI).
Main Methods:
- A prospective observational cohort study involving 180 participants (60 Endo-CABG, 60 PCI, 60 healthy controls).
- Neurocognitive tests, Quality of Life (QoL) assessments, and delirium screening were performed pre- and post-procedure, with follow-up at 3 months.
- Clinical neurological examinations and patient satisfaction surveys were also conducted.
Main Results:
- The incidence of stroke was low and comparable between Endo-CABG (1.72%) and PCI (1.67%).
- Postoperative cognitive dysfunction (POCD) and delirium rates were similar between Endo-CABG and PCI groups.
- Quality of life improved significantly post-Endo-CABG and was comparable to PCI and control groups; patient satisfaction was also comparable.
Conclusions:
- Endoscopic coronary artery bypass grafting (Endo-CABG) demonstrates a low incidence of adverse neurocognitive outcomes, including stroke, POCD, and delirium.
- The neurocognitive outcomes and patient satisfaction following Endo-CABG are comparable to those of Percutaneous Coronary Intervention (PCI).
- Endo-CABG is a safe and effective minimally invasive option for coronary artery bypass surgery.
Background/Objectives:
Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimally invasive CABG procedure with retrograde arterial perfusion. The main objective of this study is to assess neurocognitive outcome after Endo-CABG.
Methods/Design:
In this prospective observational cohort study, patients were categorised into: Endo-CABG (n = 60), a comparative Percutaneous Coronary Intervention (PCI) group (n = 60) and a healthy volunteer group (n = 60). A clinical neurological examination was performed both pre- and postoperatively, delirium was assessed postoperatively. A battery of 6 neurocognitive tests, Quality of life (QoL) and the level of depressive feelings were measured at baseline and after 3 months. Patient Satisfaction after Endo-CABG was assessed at 3-month follow-up. Primary endpoints were incidence of postoperative cognitive dysfunction (POCD), stroke and delirium after Endo-CABG. Secondary endpoints were QOL, patient satisfaction and the incidence of depressive feelings after Endo-CABG.
Results:
In total, 1 patient after Endo-CABG (1.72%) and 1 patient after PCI (1.67%) suffered from stroke during the 3-month follow-up. POCD in a patient is defined as a Reliable Change Index ≤-1.645 or Z-score ≤-1.645 in at least two tests, and was found in respectively 5 and 6 patients 3 months after Endo-CABG and PCI. Total incidence of POCD/stroke was not different (PCI: n= 7 [15.9%]; Endo-CABG: n= 6 [13.0%], p = 0.732). ICU delirium after Endo-CABG was found in 5 (8.6%) patients. QoL increased significantly three months after Endo-CABG and was comparable with QoL level after PCI and in the control group. Patient satisfaction after Endo-CABG and PCI was comparable. At follow-up, the level of depressive feelings was decreased in all groups.
Conclusions:
The incidence of poor neurocognitive outcome, including stroke, POCD and postoperative ICU delirium until three months after Endo-CABG is low and comparable with PCI.
Trial Registration:
Registered on ClinicalTrials.gov (NCT02979782).
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