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Eur J Cardiothorac Surg 2002;22:559-564
© 2002 Elsevier Science NL

Short-term and long-term neurocognitive outcome in on-pump versus off-pump CABG

^a Center for Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
^b Laboratory for Neuropsychology, Department of Internal Medicine-section Neurology, Ghent University Hospital, Ghent, Belgium

Received 18 September 2001; received in revised form 22 April 2002; accepted 1 July 2002.

* Corresponding author. Tel.: +32-9240-4588; fax: +32-9240-4555
e-mail: nathalie.stroobant{at}rug.ac.be

Objective: Neuropsychological dysfunctions are considered to be important complications of coronary artery bypass graft surgery (CABG). We examined the frequency of neuropsychological abnormalities occurring in patients undergoing CABG with (on-pump) and without (off-pump) cardiopulmonary bypass. Methods: Neuropsychological assessment with seven cognitive tasks was performed one day before, 6–7 days after (n=49) and 6 months after (n=35) surgery. The subgroup undergoing on-pump surgery (n=30 at 7 days and n=22 at 6 months) was demographically comparable to the off-pump subgroup. The on-pump group included more multiple vessel disease. Results: Repeated measures multivariate analysis of variance (using surgical group as a between-subjects factor) on the group data revealed no significant differences neither immediately after surgery nor at 6 months after surgery, compared with the preoperative performance. There were no significant differences between the on-pump and off-pump groups in post-operative neuropsychological performance soon after surgery. A significant difference was found between the two groups 6 months after surgery, with more favorable results for the off-pump group. Individual comparisons revealed that 59% of the patients of both groups undergoing CABG showed evidence of cognitive impairment soon after surgery. In 11% of the patients (all on-pump), the cognitive sequelae persisted at follow-up. Conclusion: This study showed no short-term difference between the on-pump and off-pump CABG groups. The long-term cognitive outcome revealed more favorable results for the off-pump group. Although a preference to operate multiple vessel disease with classical cardiopulmonary bypass (CPB) has to be considered, the present study shows evidence for a different pattern of early decline and late recovery of cognitive functions in patients undergoing CABG with and without CPB.

Key Words: Coronary artery bypass grafting • Cognitive brain function • Neuropsychology • Cardiopulmonary bypass • Off-pump surgery

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