title: Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial.
abstract: BACKGROUND
  Coronary artery bypass graft (CABG) surgery is associated with a decline in cognitive function, which has largely been attributed to the use of cardiopulmonary bypass (on-pump procedures). Cardiac stabilizers facilitate CABG surgery without use of cardiopulmonary bypass (off-pump procedures) and should reduce the cognitive decline associated with on-pump procedures.
  
  
  OBJECTIVE
  To compare the effect of CABG surgery with (on-pump) and without (off-pump) cardiopulmonary bypass on cognitive outcome.
  
  
  METHODS
  Randomized controlled trial conducted in the Netherlands of CABG surgery patients enrolled from March 1998 through August 2000, with 3- and 12-month follow-up.
  
  
  METHODS
  Patients scheduled for their first CABG surgery (mean age, 61 years; n = 281) were randomly assigned to off-pump surgery (n = 142) or on-pump surgery (n = 139).
  
  
  METHODS
  Cognitive outcome at 3 and 12 months, which was determined by psychologists (blinded for randomization) who administered 10 neuropsychological tests before and after surgery. Quality of life, stroke rate, and all-cause mortality at 3 and 12 months were secondary outcome measures.
  
  
  RESULTS
  Cognitive outcome could be determined at 3 months in 248 patients. Cognitive decline occurred in 21% in the off-pump group and 29% in the on-pump group (relative risk [RR], 0.65; 95% confidence interval [CI], 0.36-1.16; P =.15). The overall standardized change score (ie, improvement of cognitive performance) was 0.19 in the off-pump vs 0.13 in the on-pump group (P =.03). At 12 months, cognitive decline occurred in 30.8% in the off-pump group and 33.6% in the on-pump group (RR, 0.88; 95% CI, 0.52-1.49; P =.69). The overall standardized change score was 0.19 in the off-pump vs 0.12 in the on-pump group (P =.09). No statistically significant differences were observed between the on-pump and off-pump groups in quality of life, stroke rate, or all-cause mortality at 3 and 12 months.
  
  
  CONCLUSIONS
  Patients who received their first CABG surgery without cardiopulmonary bypass had improved cognitive outcomes 3 months after the procedure, but the effects were limited and became negligible at 12 months.
authors.affiliation: Department of Anaesthesiology, University Medical Center, PO Box 85500 (HpN E03-511), 3508 GA Utrecht, the Netherlands.
authors.forename: Diederik
authors.initials: D
authors.lastname: Van Dijk
authors.forename: Erik W L
authors.initials: EW
authors.lastname: Jansen
authors.forename: Ron
authors.initials: R
authors.lastname: Hijman
authors.forename: Arno P
authors.initials: AP
authors.lastname: Nierich
authors.forename: Jan C
authors.initials: JC
authors.lastname: Diephuis
authors.forename: Karel G M
authors.initials: KG
authors.lastname: Moons
authors.forename: Jaap R
authors.initials: JR
authors.lastname: Lahpor
authors.forename: Cornelius
authors.initials: C
authors.lastname: Borst
authors.forename: Annemieke M A
authors.initials: AM
authors.lastname: Keizer
authors.forename: Hendrik M
authors.initials: HM
authors.lastname: Nathoe
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Peter P T
authors.initials: PP
authors.lastname: De Jaegere
authors.forename: Cor J
authors.initials: CJ
authors.lastname: Kalkman
mesh_terms: D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002423:Cause of Death; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications; D011788:Quality of Life; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control