Coronary artery bypass performed without the use of cardiopulmonary bypass is associated with reduced cerebral microemboli and improved clinical results.
OBJECTIVE
Strokes and neurocognitive dysfunction have been correlated with cerebral microemboli produced during cardiopulmonary bypass (CPB). The purpose of this study was to determine whether, and to what extent, off-pump coronary artery bypass (OPCAB) reduces the occurrence of cerebral microemboli compared with traditional coronary artery bypass grafting (CABG) with CPB and to compare clinical results.


METHODS
A retrospective review of 137 patients undergoing elective CABG was performed, 70 of whom underwent traditional CABG and 67 of whom underwent OPCAB. Using transcranial Doppler ultrasonography, 40 patients (20 CABG, 20 OPCAB) were continuously monitored intraoperatively for the occurrence and pattern of cerebral microemboli.


METHODS
Private, university-affiliated tertiary care hospitals.


RESULTS
There was no statistical difference in the age, sex, or underlying comorbidities between those patients undergoing CABG and OPCAB. CABG patients did have a slightly lower preoperative ejection fraction (50.9% vs 55.5%, p = 0.03). Despite these similar preoperative characteristics, the OPCAB group experienced significant reductions in cerebral microemboli (27 vs 1,766, p = 0.003), transfusion requirements (29.9% vs 47.1%, p = 0.04), intubation time (3.3 vs 9.5 h, p < 0.001), ICU length of stay (1.5 vs 2.8 days, p = 0.02), and overall hospitalization (4.9 vs 6.6 days, p = 0.01) without an increase in mortality. Fewer strokes and deaths were observed in the OPCAB group, but these trends failed to reach statistical significance.


CONCLUSIONS
In similar patient populations, OPCAB was associated with significantly fewer cerebral microemboli and improved clinical results without an increase in mortality. We believe that these early results support OPCAB as a viable and potentially safer alternative to traditional CABG.
Bowles
B J
BJ
Department of Surgery, University of Hawaii School of Medicine, St. Francis Medical Center, Honolulu, HI, USA.
Lee
J D
JD
Dang
C R
CR
Taoka
S N
SN
Johnson
E W
EW
Lau
E M
EM
Nekomoto
K
K
D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial