Neurocognitive impairment after off-pump and on-pump coronary artery bypass graft surgery – an Iranian experience

Abstract

BackgroundCoronary artery bypass graft (CABG) surgery is one of the most commonly performed surgical procedures worldwide, and it may be accompanied by postoperative neurocognitive impairment. Although this complication has been attributed to the use of cardiopulmonary bypass, it is still a matter of debate whether the switch from on-pump to off-pump technique affects the cognitive function.ObjectiveThe aim of this study was to compare the impact of the on-pump and off-pump techniques on neurocognitive impairment in low-risk CABG surgery groups.MethodsIn a descriptive and analytic study, 201 CABG patients with left-ventricular ejection fraction >30%, and without cardiac arrhythmia were enrolled. Before the elective operation, all patients underwent neurological examination and neurocognitive test, Mini-Mental State Examination (MMSE). Two months following the operation, both on- and off-pump, the patients were re-examined by MMSE to detect any neurocognitive impairment.ResultsOut of 154 patients included in the study, 95 (61.6%) and 59 (38.3%) patients were in off-pump and on-pump groups, respectively. Mean age of the patients was 57.17 ± 9.82 years. A 2-month postoperative neurocognitive impairment was detected among 17 patients of on-pump group (28.8%) and in 28 cases of off-pump group (29.4%) (P = 0.54). The mean postoperative MMSE scores were not comparable between groups (25.01 ± 4.49 in off-pump group versus 23.73 ± 4.88 in on-pump group, P = 0.09).ConclusionThe present study revealed that in low-risk patients undergoing CABG surgery, either the techniques of on-pump or off-pump did not differ regarding the neurocognitive outcome 2 months after the procedure.

Postoperative delirium associated with prolonged decline in cognitive function and sleep disturbances after cardiac surgery

“…Previous studies have shown that POCD occurs more frequently with cardiac surgery than with other forms of surgery, with CPB being the primary contributor. However, a recent study by Farhoudi et al [15] revealed that off-pump cardiac surgery also had a similar incidence of POCD compared with POD.…”

Effect of preoperative statin therapy on early postoperative memory impairment after off-pump coronary artery bypass surgery

“…Studies have detected that cardiac surgery performed with and without CPB reduce memory power of patients after surgery. [ 6 ] The POMI is associated with poor quality of life, delayed memory, and defective skillful functions after cardiac surgery.…”

“…[ 4 ] The incidence of POMI was previously considered to be lower in off-pump coronary artery bypass (OPCAB) surgery compared to coronary artery bypass with cardiopulmonary bypass (CPB),[ 5 ] but recent studies proved the same incidence in both on and off-pump surgery. [ 6 ] OPCAB triggers repeated hemodynamic fluctuations, dislodgement of micro-emboli at the time of applying side clamp to the aorta and systemic inflammation due to tissue injury. Statin pretreatment reduces the incidence of stroke in CABG.…”

Patients’ Cognitive Status and Its Related Factors Before Coronary Artery Bypasses Grafting

“…Many patients have underlying diseases such as diabetes that can destroy microvessel walls that decrease the perfusion of the brain in these patients [8,9]. Diabetes and other vascular diseases can affect brain nutrition too that may lead to cognitive impairment [10].…”