Single crossclamp improves 6-month cognitive outcome in high-risk coronary bypass patients: The effect of reduced aortic manipulation

Hammon, John W.; Stump, David A.; Butterworth, John F.; Moody, Dixon M.; Rorie, Kashemi D.; Deal, Dwight D.; Kincaid, Edward H.; Oaks, Timothy E.; Kon, Neal D.

doi:10.1016/j.jtcvs.2005.08.057

Cited by 97 publications

(54 citation statements)

References 14 publications

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“…Our results obtained in low-risk CABG are different from Hammon et al 23 who in higher-risk cases observed reduced rates of POCD with the modified single-clamp technique but no reduction in the HITS counts. Our findings are similar to those by Mullges et al 17 who did not find any effect on the rates of POCD due to the length of the tip of the aortic cannula.…”

Section: Discussioncontrasting

confidence: 99%

Cerebral Emboli Detected by Transcranial Doppler During Cardiopulmonary Bypass Are Not Correlated With Postoperative Cognitive Deficits

Rodriguez

Rubens

Wozny

et al. 2010

Stroke

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Background and Purpose-High-intensity transient signals (HITS) are the transcranial Doppler representation of both air and solid cerebral emboli. We studied the frequency of HITS associated with different surgical maneuvers during cardiopulmonary bypass for coronary artery bypass graft surgery and their association with postoperative cognitive dysfunction (POCD). Methods-We combined 356 patients undergoing coronary artery bypass graft from 2 clinical trials who had both neuropsychological testing (before, 1 week and 3 months after surgery) and transcranial Doppler during cardiopulmonary bypass. HITS were grouped into periods that included: cannulation, cardiopulmonary bypass onset, aortic crossclamp-on, aortic crossclamp-off, side clamp-on, side clamp-off, and decannulation. POCD was defined by a decreased combined Z-score of at least 2.0 or reduction in Z-scores of at least 2.0 in 20% of the individual tests. Results-Incidence of POCD was 47.3% and 6.3% at 1 week and 3 months after surgery. There was no association between cardiopulmonary bypass counts of HITS and POCD at 1 week (Pϭ0.617) and 3 months (Pϭ0.110). No differences in HITS counts were identified at any of the surgical periods between patients with and without POCD. Factors affecting HITS counts were surgical period (PϽ0.0001), blood flow velocity (Pϭ0.012), cardiopulmonary bypass duration (Pϭ0.040), and clinical study (Pϭ0.048). Conclusions-Although cerebral microemboli have been implicated in the pathogenesis of POCD, in this study that included low-risk patients undergoing coronary artery bypass surgery, there was no demonstrable correlation between the counts of HITS and POCD. (Stroke. 2010;41:2229-2235.)

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Section: Discussioncontrasting

confidence: 99%

Cerebral Emboli Detected by Transcranial Doppler During Cardiopulmonary Bypass Are Not Correlated With Postoperative Cognitive Deficits

Rodriguez

Rubens

Wozny

et al. 2010

Stroke

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“…Several studies suggested neurocognition to be more related to aortic manipulation rather the use of extracorporeal circulation (30,31). The ROOBY trial demonstrated no difference in neurophysiological outcomes between off or on-pump groups (10).…”

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

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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...

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“…Finalmente, la ateromatosis aórtica no fue diferente entre los grupos con y sin DCPO. Si bien la ateroesclerosis es un factor de riesgo de accidentes vasculares cerebrales 44 , su relación con DCPO no es concluyente 45,[64][65][66] . Una de nuestras principales limitaciones es que las conclusiones sólo aplican a la totalidad de la población estudiada, sin permitir el análisis por subgrupos por falta de poder estadístico para ello.…”

Section: Discussionunclassified

Disfunción cognitiva después de cirugía cardiaca: Saturación cerebral e índice biespectral: estudio longitudinal

Parra

Sadurní

Doñate³

et al. 2011

Rev. méd. Chile

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Single crossclamp improves 6-month cognitive outcome in high-risk coronary bypass patients: The effect of reduced aortic manipulation

Cited by 97 publications

References 14 publications

Cerebral Emboli Detected by Transcranial Doppler During Cardiopulmonary Bypass Are Not Correlated With Postoperative Cognitive Deficits

Cerebral Emboli Detected by Transcranial Doppler During Cardiopulmonary Bypass Are Not Correlated With Postoperative Cognitive Deficits

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

Disfunción cognitiva después de cirugía cardiaca: Saturación cerebral e índice biespectral: estudio longitudinal

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