Study objectives: Strokes and neurocognitive
dysfunction have been correlated with cerebral microemboli produced
during cardiopulmonary bypass (CPB). The purpose of this study was to
determine whether, and to what extent, off-pump coronary artery bypass
(OPCAB) reduces the occurrence of cerebral microemboli compared with
traditional coronary artery bypass grafting (CABG) with CPB and to
compare clinical results.
Design and patients: A
retrospective review of 137 patients undergoing elective CABG was
performed, 70 of whom underwent traditional CABG and 67 of whom
underwent OPCAB. Using transcranial Doppler ultrasonography, 40
patients (20 CABG, 20 OPCAB) were continuously monitored
intraoperatively for the occurrence and pattern of cerebral
Setting: Private, university-affiliated
tertiary care hospitals.
Results: There was no
statistical difference in the age, sex, or underlying comorbidities
between those patients undergoing CABG and OPCAB. CABG patients did
have a slightly lower preoperative ejection fraction (50.9% vs 55.5%,
p = 0.03). Despite these similar preoperative characteristics, the
OPCAB group experienced significant reductions in cerebral microemboli
(27 vs 1,766, p = 0.003), transfusion requirements (29.9% vs 47.1%,
p = 0.04), intubation time (3.3 vs 9.5 h, p < 0.001), ICU
length of stay (1.5 vs 2.8 days, p = 0.02), and overall
hospitalization (4.9 vs 6.6 days, p = 0.01) without an increase in
mortality. Fewer strokes and deaths were observed in the OPCAB group,
but these trends failed to reach statistical significance.
Conclusions: In similar patient populations, OPCAB was
associated with significantly fewer cerebral microemboli and improved
clinical results without an increase in mortality. We believe that
these early results support OPCAB as a viable and potentially safer
alternative to traditional CABG.