Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial

Abstract

Objective To compare the clinical, angiographic, neurocognitive, and quality of life outcomes of off-pump coronary artery bypass surgery with conventional coronary artery bypass grafting surgery using cardiopulmonary bypass. Design Randomised controlled clinical trial. Setting Tertiary cardiothoracic centre in Middlesex, England. Participants 168 patients (27 women) requiring primary isolated coronary artery bypass grafting surgery. Interventions Patients were randomised to conventional coronary artery bypass grafting surgery using cardiopulmonary bypass (n = 84) or off-pump coronary artery bypass surgery (n = 84), carried out by one surgeon. Angiographic examination was carried out at three months postoperatively. Neurocognitive tests were carried out at baseline and at six weeks and six months postoperatively. Main outcome measures Clinical outcome, graft patency at three months, neurocognitive function at six weeks and six months, and health related quality of life. Results Graft patency was evaluated by angiography in 151 (89.9%) patients and was similar between the cardiopulmonary bypass and off-pump groups (risk difference − 1%, 95% confidence interval − 5% to 4%), with the off-pump group considered the treatment group. Patients in the off-pump group required fewer blood transfusions (1.7 units v 1.0 unit, P = 0.02), shorter duration of mechanical ventilation (7.7 hours v 3.9 hours, P = 0.03), and shorter hospital stay (10.8 days v 8.9 days). Scores for neurocognitive function showed a significant difference in three memory subtests at six weeks and two memory subtests at six months in favour of the off-pump group. Conclusions Patients who underwent off-pump coronary artery bypass surgery showed similar patency of grafts, better clinical outcome, shorter hospital stay, and better neurocognitive function than patients who underwent conventional coronary artery bypass grafting surgery using cardiopulmonary bypass.

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

“…Ascione and Angelini (5) discussed the dilemma faced by many cardiac surgeons who perform CABG. On one hand, the literature is replete with studies that emphasize the potential for reducing postoperative morbidity and length of stay with OPCAB surgery (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24); on the other hand, there is continued concern regarding intraoperative myocardial ischemia, inadequate revascularization and the need for early revascularization (5,8,23,(25)(26)(27)(28)(29).…”

Current Evidence of On-Pump Versus Off-Pump Coronary Artery By-Pass Surgery

“…In this questionnaire eight scales cover physical, mental, and social well-being (28). One study found a significantly higher score among CCABG-patients in one of the eight scales ("Role emotional") in contrast to another study who favoured OPCAB patients in the dimension "Social Relationships", using another questionnaire (29,30). In general, few significant inter-group differences have been found, given the multiple tests being performed.…”

Risk Factors for the Development of Post-Operative Cognitive Dysfunction

“…The incidence of pre-existing cognitive impairment in patients undergoing cardiac surgery is 35-45% (Hogue et al, 2006;Silbert et al, 2007) and the incidence of deterioration of cognitive function after cardiac surgery varies at a rate of 25-80% (Rasmussen et al, 2001). These study results depend on the type of surgery, the cardiac patients being studied, the method to determine POCD, the surgical practice, the protocols implemented by individual medical centres and surgical teams and the post-operative time that cognitive assessment is made (Al Ruzzeh et al, 2006). The logical conclusion from these studies, as summarized in the review of Taggart et al is the avoidance of these types of surgical operations whenever possible (Taggart & Westaby, 2001).…”