title: Off-pump coronary artery bypass grafting reduces postoperative neurologic complications.
abstract: OBJECTIVE
  Complications occurring after coronary artery bypass graft (CABG) surgery, particularly neurologic damage, have been mainly correlated with the use of cardiopulmonary bypass (CPB). The aim of this work was to compare postoperative outcomes of patients undergoing CABG surgery, with or without the use of CPB, focusing on neurologic events.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  University tertiary care hospital.
  
  
  METHODS
  Two thousand seven hundred and forty consecutive patients who underwent CABG surgery in the period January 1998 to January 2003.
  
  
  METHODS
  None.
  
  
  RESULTS
  For 738 patients, the operation was performed off-pump (OP group), and for 2002 patients CPB was used (CPB group). OP and CPB groups were compared with regard to preoperative status, anesthetic management, and postoperative outcomes, by means of univariate and multivariate analyses. Surgeons' propensity to operate off-pump was based on patients' age, renal conditions, and hemodynamics. Univariate and multivariate analyses showed that CPB was associated with a higher incidence of type I neurologic events compared with OP technique (2.1% versus 0.9%, odds ratio [OR]: 2.6, 95% confidence interval [CI], 1.2-5.9). A history of previous stroke (OR: 2.7, 95% CI, 1.2-5.9) and advanced age (OR: 1.06 per year, 95% CI, 1.02-1.09) were additional independent predictors of postoperative type I neurologic events.
  
  
  CONCLUSIONS
  In the authors' experience, off-pump CABG surgery offers some benefits compared with CPB in respect to major neurologic complications.
authors.affiliation: Department of Cardiovascular Anesthesia, IRCCS San Raffaele Hospital, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Crescenzi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Albino
authors.initials: A
authors.lastname: Leoni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marino
authors.forename: Maria G
authors.initials: MG
authors.lastname: Calabrò
authors.forename: Chiara
authors.initials: C
authors.lastname: Corno
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D000704:Analysis of Variance; D000758:Anesthesia; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006979:Hyperthermia, Induced; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome