Cognitive outcomes in elderly high-risk patients after off-pump versus conventional coronary artery bypass grafting: a randomized trial.
BACKGROUND
It has been suggested that the risk of cerebral dysfunction is less with off-pump coronary artery bypass grafting (OPCAB) than with conventional coronary artery bypass grafting (CCAB). However, evidence for this statement is preliminary, and additional insight is needed.


RESULTS
The study was a substudy of the randomized Best Bypass Surgery trial that compared OPCAB with CCAB treatment with respect to intraoperative and postoperative mortality and morbidity in patients with a moderate to high level of predicted preoperative risk. The outcome was cognitive function. A total of 120 elderly patients (mean age 76 years, SD 4.5 years) underwent psychometric testing before surgery and at a mean of 103 (SD 15) days postoperatively with a neuropsychological test battery that included 7 parameters from 4 tests. Cognitive dysfunction was defined as the occurrence of at least 2 of the 7 possible deficits. Secondary analysis was performed on the basis of the definition of a 20% decline in cognitive scores compared with baseline, and with z score analysis. Cognitive dysfunction was identified in 4 of the 54 patients (7.4%, 95% confidence interval [CI] 2.1% to 17.9%) in the OPCAB group and 5 of the 51 patients (9.8%, 95% CI 3.3% to 21.4%) in the CCAB group. We found no difference in incidence of cognitive dysfunction between the groups regardless of the definition applied.


CONCLUSIONS
In elderly high-risk patients, no significant difference was found in the incidence of cognitive dysfunction 3 months after either OPCAB or CCAB.
Jensen
Birte Ostergaard
BO
Department of Cardiothoracic Surgery, The Heart Center, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. Birtej@rh.dk
Hughes
Pia
P
Rasmussen
Lars S
LS
Pedersen
Preben U
PU
Steinbrüchel
Daniel A
DA
D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015897:Comorbidity; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology