No improvement in neurocognitive outcomes after off-pump versus on-pump coronary revascularisation: a meta-analysis

Marasco, Silvana; Sharwood, Lisa N.; Abramson, Michael J.

doi:10.1016/j.ejcts.2008.03.022

Cited by 88 publications

(47 citation statements)

References 47 publications

(70 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The ROOBY trial demonstrated no difference in neurophysiological outcomes between off or on-pump groups (10). Similarly, three other randomized trials (32)(33)(34) and two systematic reviews of RCTs (35,36) failed to show any benefit with OPCAB in terms of neurocognitive function ( Tables 5,6). …”

Section: =0%) (1)mentioning

confidence: 99%

Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials

et al. 2016

View full text Add to dashboard Cite

Coronary artery bypass grafting remains the standard treatment for patients with extensive coronary artery disease. Coronary surgery without use of cardiopulmonary bypass avoids the deleterious systemic inflammatory effects of the extracorporeal circuit. However there is an ongoing debate surrounding the clinical outcomes after on-pump versus off-pump coronary artery bypass (ONCAB versus OPCAB) surgery. The current review is based on evidence from randomized controlled trials (RCTs) and metaanalyses of randomized studies. It focuses on operative mortality, mid-and long-term survival, graft patency, completeness of revascularisation, neurologic and neurophysiologic outcomes, perioperative complications and outcomes in the high risk groups. Early and late survival rates for both OPCAB and ONCAB grafting are similar. Some studies suggest early poorer vein graft patency with off-pump when compared with onpump, comparable midterm arterial conduit patency with no difference in long term venous and arterial graft patency. A recent, pooled analysis of randomised trials shows a reduction in stroke rates with use offpump techniques. Furthermore, OPCAB grafting seems to reduce postoperative renal dysfunction, bleeding, transfusion requirement and respiratory complications while perioperative myocardial infarction rates are similar to ONCAB grafting. The high risk patient groups seem to benefit from off-pump coronary surgery. Developed about 40 decades ago (5-7), OPCAB reached a plateau in Europe, accounting for nearly 15-20% of all coronary operations, while in Asia 60-100% of patients are offered coronary artery bypass grafting (2). A retrospective analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database in USA revealed a decline in off-pump operations, currently being used in fewer than one out of five patients (8). The current review focuses on the main outcomes of on-pump coronary artery bypass (ONCAB) grafting versus OPCAB from randomized controlled trials (RCTs) (i.e., level I evidence). The main criticism of RCTs in this area, is the under powering because of recruitment of low risk patients but also because of the low mortality and morbidity of coronary artery bypass grafting that would require very large sample populations to detect a difference (4). Therefore, we will also be reviewing pooled data from recent, updated meta-analyses of randomized trials only. We selected in our review large sample size RCTs or large meta-analyses of RCTs to discuss the hard end-point outcomes but smaller trials were also included to discuss other outcomes. Operative mortalityThe majority of the large RCTs to date failed to show a difference in early mortality between off-pump and on-pump surgery (1,3,9-13). One small sample size RCT by Fattouch et al. showed a reduced mortality in patients with ST elevation undergoing urgent/emergent off-pump coronary surgery compared to on-pump surgery (14). Deppe et al. in meta-analysis of RCTs on almost 16,900 patients found no difference in 30-day mortality. Kow...

show abstract

Section: =0%) (1)mentioning

confidence: 99%

Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Similarly, rates of POCD after cardiac surgery with or without CPB were not significantly different in elderly patients, one year (Jensen et al, 2006) or five years after surgery (Van Dijk et al, 2007). This was confirmed in a meta-analysis which included data of more than 900 patients (Marasco et al, 2008). Table 1.…”

Section: Association With Surgical Operationsmentioning

confidence: 53%

“…Cognitive dysfunction due to lack of normal sleep (Misra &Malow, 2008;Walker, 2008) Type of surgery POCD after minor surgery (Canet et al, 2003) POCD after major surgery (Moller et al, 1998) POCD after cardiac surgery (Pugsley et al, 1994;Newman et al, 2001;Rasmussen et al, 2001;Taggart & Westaby, 2001;Hogue et al, 2006;Jensen et al, 2006;Smith et al, 2006;Silbert et al, 2007;Van Dijk et al, 2007;Marasco et al, 2008;Evered et al, 2011) …”

Section: Metabolic Syndromementioning

confidence: 99%

Risk Factors for the Development of Post-Operative Cognitive Dysfunction

Pappa¹,

Theodosiadis²,

Tsounis³

et al. 2016

GJHS

View full text Add to dashboard Cite

Background: Many studies have shown that a large number of patients undergoing surgery show a measurable cognitive deterioration after surgery, while many of them still show cognitive deficits even three months later an operation. These specific cognitive deficits in which there is a temporal association between surgery and mental disorders are defined as postoperative impairment of cognitive function. Among cognitive disorders occurring during the postoperative period, the post-operative cognitive dysfunction (POCD) is less studied.Aim: Risk factors concerning POCD will be overviewed in order to be considered as a measure of prevention of POCD.Method: A literature search using combined keywords was undertaken on bibliographic databases including PubMed, Google Scholar and Scopus and through systematic selection 72 scientific articles were identified. Concerning the selection criteria, the material of this study consists of sources published mainly over the last fifteen years, while some articles that published before 2000 were selected because they were considered to be important.Results: These disorders frequently occur in patients of advanced age. It is obvious that as the population of humanity ages, many older people are likely to develop health problems that require surgery and therefore a large number of people are likely to develop post-operative cognitive disorders. For the appearance of POCD, as for other mental disorders (e.g. delirium), several factors are implicated. According to the findings, except the advanced age, genetic polymorphism, idiosyncratic condition, the presence of metabolic syndrome and neurological diseases, the type of anaesthesia and surgical operation and sleep disturbance are among the most important risk factors.

show abstract

“…Diğer yandan, Jensen ve ark.nın [11] araştırmasında KPB altında KABG ile atan kalpte KABG arasında ameliyat sonrası kognitif fonksiyon bozukluğu açısından anlamlı bir fark bulunmamıştır. Marasco ve ark.nın [15] yaptıkları meta-analiz çalışması bu araştırma sonucunu desteklemektedir. Hudetz ve ark.…”

Section: Nörokognitif Fonksiyon Bozukluğunun Belirlenmesiunclassified

Neurocognitive dysfunction after cardiac surgery and biochemical markers

Öztürk¹

2013

Turk Gogus Kalp Dama

View full text Add to dashboard Cite

No improvement in neurocognitive outcomes after off-pump versus on-pump coronary revascularisation: a meta-analysis

Cited by 88 publications

References 47 publications

Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials

Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials

Risk Factors for the Development of Post-Operative Cognitive Dysfunction

Neurocognitive dysfunction after cardiac surgery and biochemical markers

Contact Info

Product

Resources

About