Korean J Thorac Cardiovasc Surg.  2000 Dec;33(12):941-947.

Central Nervous System Complications of Coronary Artery Bypass Grafting - Comparison Between Off - Pump CABG and Conventional CABG

• Chang JM
• Lee JS
• Kim KB
• Ahn H
• Yoon BW
• Kim YJ

Abstract

BACKGROUND: Central nervous system complication after coronary artery bypass grafting (CABG) is one of the major prognostic determinants and the use of the cardiopulmonary bypass(CPB) may increase the incidence of this devastating complication. In this study, the outcomes after off-pump CABG were studied and compared with those following the conventional CABG using CPB. MATERIAL AND METHOD: Among the consecutive isolated CABG's performed in SNUH during Feb. 1995 and Jun. 1999, 338 coronary artery bypass grafting were divided into two groups. 223 patients underwent CABG using the CPB(Group I), and 115 patients underwent CABG without CPB(OPCAB)(Group II). All patients enrolled in this study received extensive preoperative examinations including thorough neurologic examination before and after surgery, transcranial doppler study, carotid duplex ultrasonography, and magnetic resonance angiography if necessary. Central nervous system(CNS) complications were defined as stroke, seizure, metabolic or hypoxic encephalopathy and transient delirium after surgery. RESULT: There were 61 cases(27.3%) who developed postoperative CNS complication in Group I, whereas 8 cases(7.0%) of CNS complications developed postoperatively in group II(p<0.05). Statistically significant predictors of postoperative CNS complications in group I were age and the use of cardiac assist devices perioperatively.
CONCLUSION
This study suggested that omitting the use of CPB in CABG resulted in significant decrease of the postoperative CNS complications. OPCAB should be more widely applied especially to the elderly who have preexisting cerebrovascular disease.

Keyword

Coronary arterial bypass; Central nervous system; Cardiopulmonary bypass; Postoperative complications

MeSH Terms

Aged
Cardiopulmonary Bypass
Central Nervous System*
Coronary Artery Bypass*
Coronary Vessels*
Delirium
Humans
Hypoxia, Brain
Incidence
Magnetic Resonance Angiography
Neurologic Examination
Postoperative Complications
Seizures
Stroke
Ultrasonography