Cognitive and cardiac outcomes 5 years after off-pump vs on-pump coronary artery bypass graft surgery.
BACKGROUND
Conventional coronary artery bypass graft surgery with use of cardiopulmonary bypass (on-pump CABG) is associated with excellent long-term cardiac outcomes but also with a high incidence of cognitive decline. The effect of avoiding cardiopulmonary bypass (off-pump CABG) on long-term cognitive and cardiac outcomes is unknown.


OBJECTIVE
To compare the effect of off-pump CABG and on-pump CABG surgery on long-term cognitive and cardiac outcomes.


METHODS
The Octopus Study, a multicenter randomized controlled trial conducted in the Netherlands, which enrolled 281 low-risk CABG patients between 1998 and 2000. Five years after their surgery, surviving patients were invited for a follow-up assessment.


METHODS
Patients were randomly assigned to receive either off-pump (n = 142) or on-pump (n = 139) CABG surgery.


METHODS
The primary measure was cognitive status 5 years after surgery, which was determined by a psychologist blinded to treatment allocation who administered 10 standardized validated neuropsychological tests. Secondary measures were occurrence of cardiovascular events (all-cause mortality, stroke, myocardial infarction, and coronary reintervention), anginal status, and quality of life.


RESULTS
After 5 years, 130 patients were alive in each group. Cognitive outcomes could be determined in 123 and 117 patients in the off-pump and on-pump groups, respectively. When using a standard definition of cognitive decline (20% decline in performance in 20% of the neuropsychological test variables), 62 (50.4%) of 123 in the off-pump group and 59 (50.4%) of 117 in the on-pump group had cognitive decline (absolute difference, 0%; 95% confidence interval [CI], -12.7% to 12.6%; P>.99). When a more conservative definition of cognitive decline was used, 41 (33.3%) in the off-pump group and 41 (35.0%) in the on-pump group had cognitive decline (absolute difference, -1.7%; 95% CI, -13.7% to 10.3%; P = .79). Thirty off-pump patients (21.1%) and 25 on-pump patients (18.0%) experienced a cardiovascular event (absolute difference, 3.1%; 95% CI, -6.1% to 12.4%; P = .55). No differences were observed in anginal status or quality of life.


CONCLUSIONS
In low-risk patients undergoing CABG surgery, avoiding the use of cardiopulmonary bypass had no effect on 5-year cognitive or cardiac outcomes.


BACKGROUND
isrctn.org Identifier: ISRCTN69438133.
van Dijk
Diederik
D
Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands. d.vandijk@umcutrecht.nl
Spoor
Monique
M
Hijman
Ron
R
Nathoe
Hendrik M
HM
Borst
Cornelius
C
Jansen
Erik W L
EW
Grobbee
Diederick E
DE
de Jaegere
Peter P T
PP
Kalkman
Cor J
CJ
D000368:Aged; D003071:Cognition; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011788:Quality of Life; D016896:Treatment Outcome