JAMA
Cognitive and Cardiac Outcomes 5 Years After Off-Pump vs On-Pump Coronary Artery Bypass Graft Surgery
Diederik van Dijk, MD, PhD; Monique Spoor, MS; Ron Hijman, PhD; Hendrik M. Nathoe, MD, PhD; Cornelius Borst, MD, PhD; Erik W. L. Jansen, MD, PhD; Diederick E. Grobbee, MD, PhD; Peter P. T. de Jaegere, MD, PhD; Cor J. Kalkman, MD, PhD; for the Octopus Study Group
Context:
Conventional coronary artery bypass graft surgery with use of cardiopulmonary bypass (on-pump CABG) is associated with excellent long-term cardiac outcomes but also with a high incidence of cognitive decline. The effect of avoiding cardiopulmonary bypass (off-pump CABG) on long-term cognitive and cardiac outcomes is unknown.
Objective:
To compare the effect of off-pump CABG and on-pump CABG surgery on long-term cognitive and cardiac outcomes.
Design, Setting, and Participants:
The Octopus Study, a multicenter randomized controlled trial conducted in the Netherlands, which enrolled 281 low-risk CABG patients between 1998 and 2000. Five years after their surgery, surviving patients were invited for a follow-up assessment.
Intervention:
Patients were randomly assigned to receive either off-pump (n = 142) or on-pump (n = 139) CABG surgery.
Main Outcome Measure:
The primary measure was cognitive status 5 years after surgery, which was determined by a psychologist blinded to treatment allocation who administered 10 standardized validated neuropsychological tests. Secondary measures were occurrence of cardiovascular events (all-cause mortality, stroke, myocardial infarction, and coronary reintervention), anginal status, and quality of life.
Results:
After 5 years, 130 patients were alive in each group. Cognitive outcomes could be determined in 123 and 117 patients in the off-pump and on-pump groups, respectively. When using a standard definition of cognitive decline (20% decline in performance in 20% of the neuropsychological test variables), 62 (50.4%) of 123 in the off-pump group and 59 (50.4%) of 117 in the on-pump group had cognitive decline (absolute difference, 0%; 95% confidence interval [CI], −12.7% to 12.6%; P > .99). When a more conservative definition of cognitive decline was used, 41 (33.3%) in the off-pump group and 41 (35.0%) in the on-pump group had cognitive decline (absolute difference, −1.7%; 95% CI, −13.7% to 10.3%; P = .79). Thirty off-pump patients (21.1%) and 25 on-pump patients (18.0%) experienced a cardiovascular event (absolute difference, 3.1%; 95% CI, −6.1% to 12.4%; P = .55). No differences were observed in anginal status or quality of life.
Conclusion:
In low-risk patients undergoing CABG surgery, avoiding the use of cardiopulmonary bypass had no effect on 5-year cognitive or cardiac outcomes.
Trial Registration:
isrctn.org Identifier: ISRCTN69438133
JAMA. 2007;297(7):701-708.