2002 Papers - Yamauchi


Off Pump Coronary Artery Bypass Reduces Neurologic and Clinical Morbidity: A Prospective Randomized Trial
Hideko Yamauchi, M.D., Jeffrey D. Lee, M.D., Shay J. Lee, M.D., William T. Tsushima, PhD, William T. Lau, Jordan Popper, M.D., Alan Stein, M.D., David Johnson, David Lee, D.O., Helen Petrovitch, M.D., and Collin R. Dang, M.D.

Introduction: Neurologic and clinical morbidity following Coronary Artery Bypass Grafting (CABG) can be significant. Off Pump Coronary Artery Bypass (OPCAB) may be a less invasive alternative. This prospective randomized study compares the neurologic and clinical morbidity associated with these two procedures.

Methods: 60 pts were prospectively randomized into 2 gps (30 OPCAB and 30 CABG) from 4/99 to 9/01. Neurologic function was assessed using a battery of tests: 1)NIH Stroke Scale 2)Vocab-WAIS III 3)Rey Auditory Verbal Learning (RAVLT) 4)Benton Visual Retention(BVR) 5)Trail Making 6)Grooved Pegboard (GP) 7)Finger Tapping 8)Digit Symbol-WAIS III 9)State -Trait Anxiety(STA) 10) Beck Depression II. Neurocognitive testing was performed preop, and 2 wks and 1 yr postop. Transcranial Doppler of bilat. mid. cerebral arteries were performed intraop to detect cerebral microemboli. Brain SPECT scanning with Tc99m-HMPAO evaluated brain perfusion pre and 3 days postop. Bleeding, transfusions, inotrope use, and other parameters were compared to assess clinical morbidity. Overall cost was compared.

Results: CABG had significantly more cerebral microemboli (646 CABG vs. 26 OPCAB, p<0.001), and significantly less perfusion to the bilateral occipital, cerebellar, percunei, thalmi, and left temporal lobe postoperatively, while the OPCAB gp had no change (p<0.01). Better performance on the RAVLT at both 2 weeks and 1 year compared with preop were seen in the OPCAB gp (p<0.05), but not in the CABG gp. One stroke was seen in the CABG gp(p=NS). OPCAB had significantly less chest tube drainage (1389 ml CABG vs. 789 ml OPCAB, p=0.021), requirement of transfusions (3.9 units CABG vs. 1.2 units OPCAB, p=0.025), FFP (3.0 units CABG vs. 0.5 units OPCAB, p=0.035), dopamine (16.3 hrs CABG vs. 7.3 hrs OPCAB, p=0.038), and overall cost ($23,040 CABG vs. $17,436 OPCAB, p<0.001),

Conclusion: Patients who underwent OPCAB had significantly better neurocognitive function postop. Related factors may be fewer cerebral microemboli, and better postoperative brain perfusion. Reduced clinical morbidity and cost was seen as well.