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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
JAMA. 2007;297:701-708.
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
Author Affiliations: Departments of Anesthesiology (Drs van Dijk and Kalkman and Ms Spoor), Psychiatry (Dr Hijman), Cardiology (Drs Nathoe and Borst), and Cardiothoracic Surgery (Dr Jansen) and the Julius Center for Patient Oriented Research (Dr Grobbee), University Medical Center Utrecht, Utrecht, the Netherlands; and the Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands (Dr de Jaegere).
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