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| Neurocognitive and Neuroanatomic Changes After Off-Pump Versus On-Pump CABG: Long-Term Follow-up of a Randomized Trial |
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John D. Puskas1, Anthony Stringer1, Scott N. Hwang1, Brannon Hatfield1, A. Shannon Smith1, Patrick Kilgo2, Willis H. Williams1; 1Cardiothoracic Surgery, Emory University, Atlanta, GA; 2Rollins School of Public Health, Emory University, Atlanta, GA Objective: It is unknown whether avoidance of cardiopulmonary bypass (CPB) during CABG impacts intraoperative cerebral injury or long-term postoperative neuropsychological function. Methods: 200 unselected patients with multi-vessel coronary artery disease were randomized to off-pump (OPCAB) or on-pump (CPB) CABG between March 2000 and August 2001. 168 patients had postoperative brain MRI (1.5 T) prior to hospital discharge. Of 148 long-term survivors, 87 returned after a mean 7.5 yrs (range 6.8 - 8.4 yrs) for clinical follow-up; 67 had repeat MRI and 76 had neuropsychological tests covering domains including attention, memory and executive functions, administered by a neuropsychologist. MRI images were scored by a neuroradiologist. Atrophy in the temporal and frontal lobes, subcortical/periventricular white matter lesions (T2-weighted or FLAIR images indicating any cerebral injury) and diffusion-restricted lesions (early cerebral infarctions) were rated on ordinal scales and compared between groups using Wilcoxon tests. Results: There were 22 deaths from all causes among OPCAB patients and 27 among CPB patients as of March 30, 2009. 76 patients (41 CPB; 35 OPCAB) had neuropsychological testing at late follow-up. Groups were similar with respect to potential confounders such as age, gender, depression and IQ. OPCAB patients showed better attention, performing better at simultaneously tracking and mentally manipulating visual information (p=0.011). OPCAB patients showed a trend towards better verbal learning (p=0.064). There were no significant differences between groups in visuospatial memory. OPCAB patients showed better cognitive reasoning and made fewer errors in reasoning (p=0.05). There were no domains in which CPB patients outperformed OPCAB patients. Early MRI in 168 patients showed no significant differences between groups in atrophy, subcortical white matter lesions or acute infarctions. Among 59 patients who had both early and late MRI, there were no significant differences between groups with respect to atrophy over time or new subcortical white matter lesions or infarctions. Conclusion: After mean 7.5 yr follow-up in this randomized trial, OPCAB was associated with superior neuropsychological function compared to CPB. Early brain MRI showed no significant differences in acute cerebral infarctions between the OPCAB and CPB groups. Repeat MRI at late follow-up showed similar atrophic changes in both groups. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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