title: Cerebral ischemic injury and cognitive impairment after off-pump and on-pump coronary artery bypass grafting surgery.
abstract: BACKGROUND
  Off-pump coronary artery bypass grafting surgery reduces the intraoperative cerebral embolic load and may therefore cause less brain injury. The main aim of this study was to compare off-pump and on-pump surgery with regard to the frequency of new postoperative cerebral ischemic lesions and the prevalence of postoperative cognitive impairment. We also assessed whether preoperative cerebral ischemic injury predicts the risk for cognitive dysfunction after surgery.
  
  
  METHODS
  One hundred twenty patients with ischemic coronary artery disease were prospectively randomized to undergo off-pump or on-pump surgery. A detailed neuropsychological assessment and a cerebral magnetic resonance imaging examination were performed on the day before and at 3 months postoperatively. The neuropsychological assessment was repeated at 12 months.
  
  
  RESULTS
  There was no significant (p = 0.17) difference between off-pump (8.2%) and on-pump (17.3%) surgery with regard to new postoperative cerebral lesions. The prevalence of cognitive impairment after surgery was also similar in the two groups (3 months: off-pump 20.4%, on-pump 23.1%, p = 0.74; 12 months: off-pump 24.1%, on-pump 23.1%, p = 0.90). The degree of preoperative cerebral ischemic injury was significantly associated with cognitive dysfunction after on-pump (p = 0.02) but not after off-pump (p = 0.22) surgery. None of the patients with normal preoperative radiologic findings were found to have cognitive impairment at 3 months postoperatively (p = 0.04).
  
  
  CONCLUSIONS
  Long-term cognitive function and magnetic resonance imaging evidence of brain injury were similar after off-pump and on-pump coronary artery bypass grafting surgery. Preoperative cerebral magnetic resonance imaging can be used to predict the risk for cognitive dysfunction after coronary artery bypass grafting surgery.
authors.affiliation: Department of Neurology, Rikshospitalet University Hospital, Oslo, Norway. christian.lund@rikshospitalet.no
authors.forename: Christian
authors.initials: C
authors.lastname: Lund
authors.forename: Kjetil
authors.initials: K
authors.lastname: Sundet
authors.forename: Bjørn
authors.initials: B
authors.lastname: Tennøe
authors.forename: Per K
authors.initials: PK
authors.lastname: Hol
authors.forename: Kjell A
authors.initials: KA
authors.lastname: Rein
authors.forename: Erik
authors.initials: E
authors.lastname: Fosse
authors.forename: David
authors.initials: D
authors.lastname: Russell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery*; D015995:Prevalence; D011446:Prospective Studies