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On- vs. Off-Pump CABG: Cognitive Outcomes

In a study from the Netherlands of 281 selected patients randomized to on- or off-pump coronary artery bypass grafting, short-term cardiac outcomes did not differ between groups (Journal Watch Cardiology Jan 11 2002). Now, the investigators present 3-month and 1-year cognitive-outcome data.

Trained psychologists assessed cognitive function with 10 pre- and post-surgery neuropsychological tests. By 3 months, cognitive decline had occurred in 21% of the off-pump group and in 29% of the on-pump group (P=0.15); by 12 months, the rates were 31% and 34%, respectively (P=0.69). No statistically significant between-groups differences were noted at 3 or 12 months in the secondary outcomes of quality of life, stroke rate, and all-cause mortality.

Comment: In this important study of patients undergoing elective CABG, long-term cognitive outcomes did not differ after off- versus on-pump surgery. As the editorialists note, however, this study was underpowered to detect meaningful cognitive-outcome differences between the 2 approaches. Furthermore, the cohort was significantly younger and had a substantially lower risk for adverse outcomes than U.S. patients who undergo off-pump CABG. Although this study provides important, new data on the effect of off-pump CABG on long-term cognitive function, only larger randomized trials can offer clearer answers.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology April 26, 2002

Citation(s):

van Dijk D et al. for the Octopus Study Group. Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: A randomized trial. JAMA 2002 Mar 20; 287:1405-12.

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• Medline abstract (Free)

Mark DB and Newman MF. Protecting the brain in coronary artery bypass graft surgery. JAMA 2002 Mar 20; 287:1448-50.

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• Medline abstract (Free)