SAN DIEGO, Jan. 29 -- Off-pump coronary artery bypass graft (CABG) offers no advantage for cognitive function over on-pump surgery, researchers said here.
SAN DIEGO, Jan. 29 -- Off-pump coronary artery bypass graft (CABG) offers no advantage for cognitive function over conventional on-pump surgery, researchers said here.
Overall neurocognitive function was no different between the two revascularization methods early in the recovery period or six months later, said Felix Hernandez, Jr., M.D., of the Eastern Main Medical Center in Bangor, and colleagues, at the Society of Thoracic Surgeons meeting.
In the study, the researchers prospectively randomized 201 non-emergent patients to on-pump or off-pump procedures. Participants also underwent a battery of neuropsychological tests before the operation, at hospital discharge, and six months later.
The CABG patients were ages 40 to 80 and had procedures from 2001 to 2004. Patient s needing concomitant valve or carotid artery procedures, emergency operations, reoperations, or several other risk factors were excluded.
The researchers found no significant difference in the primary endpoints of neurocognitive decline, defined as at least a 20% reduction from baseline in at least 20% of the tests. The on-pump versus off-pump findings were:
All but three individual psychocognitive tests likewise showed no difference between groups at discharge or six-month follow-up. The exceptions were:
Dr. Hernandez and colleagues concluded that off-pump CABG may offer some advantages over on-pump procedures but neurocognitive function is not included among them.
Commenting on the study, William A. Walker, M.D., of the Johnson City Medical Center Hospital, in Johnson City, Tenn., it was hoped that the off-pump procedure would eliminate declines in cognitive function, but the off-pump procedures failed to deliver for the majority of patients.
"It's not a panacea to solve all the problems we had with on-pump CABG," he said.