Beating heart surgery or conventional CABG: are neurologic outcomes different?
Although there has been much debate about the causes of neurologic complications associated with coronary artery bypass grafting (CABG), there is good evidence linking such complications with some of the pathophysiologic changes associated with use of conventional cardiopulmonary bypass (CPB). Several studies indicate that it is possible to significantly lower risk of stroke and other central nervous system (CNS) morbidity in patients undergoing CPB for CABG by application of selected techniques and equipment modifications. The resurgence of interest in coronary revascularization by using beating heart surgery (BHS) offers a unique opportunity to evaluate neurologic outcome independent of CPB. Currently, BHS would appear to significantly reduce morbidity in the elderly and to decrease the costs and resource use in coronary revascularization patients. It is hoped that by understanding the mechanisms of CNS injury associated with CABG, techniques can be developed to decrease the risk of neurologic injury associated with coronary revascularization, whether or not CPB is used. Definitive conclusions regarding outcomes after best practice CPB or BHS await large-scale, risk-stratisfied multicenter trials.
Iglesias
I
I
Department of Cardiac Anesthesiology, University Hospital Campus-LHSC, University of Western Ontario, London, Ontario, Canada.
Murkin
J M
JM
D000367:Age Factors; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002490:Central Nervous System / Q000293:injuries* / Q000502:physiology; D001026:Coronary Artery Bypass / Q000009:adverse effects; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D014481:United States / Q000453:epidemiology