Lund Christian, Sundet Kjetil, Tennøe Bjørn, Hol Per K, Rein Kjell A, Fosse Erik, Russell David
Department of Neurology, Rikshospitalet University Hospital, Oslo, Norway.
Ann Thorac Surg. 2005 Dec;80(6):2126-31. doi: 10.1016/j.athoracsur.2005.06.012.
Off-pump coronary artery bypass grafting surgery reduces the intraoperative cerebral embolic load and may therefore cause less brain injury. The main aim of this study was to compare off-pump and on-pump surgery with regard to the frequency of new postoperative cerebral ischemic lesions and the prevalence of postoperative cognitive impairment. We also assessed whether preoperative cerebral ischemic injury predicts the risk for cognitive dysfunction after surgery.
One hundred twenty patients with ischemic coronary artery disease were prospectively randomized to undergo off-pump or on-pump surgery. A detailed neuropsychological assessment and a cerebral magnetic resonance imaging examination were performed on the day before and at 3 months postoperatively. The neuropsychological assessment was repeated at 12 months.
There was no significant (p = 0.17) difference between off-pump (8.2%) and on-pump (17.3%) surgery with regard to new postoperative cerebral lesions. The prevalence of cognitive impairment after surgery was also similar in the two groups (3 months: off-pump 20.4%, on-pump 23.1%, p = 0.74; 12 months: off-pump 24.1%, on-pump 23.1%, p = 0.90). The degree of preoperative cerebral ischemic injury was significantly associated with cognitive dysfunction after on-pump (p = 0.02) but not after off-pump (p = 0.22) surgery. None of the patients with normal preoperative radiologic findings were found to have cognitive impairment at 3 months postoperatively (p = 0.04).
Long-term cognitive function and magnetic resonance imaging evidence of brain injury were similar after off-pump and on-pump coronary artery bypass grafting surgery. Preoperative cerebral magnetic resonance imaging can be used to predict the risk for cognitive dysfunction after coronary artery bypass grafting surgery.
非体外循环冠状动脉搭桥手术可降低术中脑栓塞负荷，因此可能导致较少的脑损伤。本研究的主要目的是比较非体外循环和体外循环手术在术后新发脑缺血性病变的频率和术后认知功能障碍的患病率方面的差异。我们还评估了术前脑缺血损伤是否可预测术后认知功能障碍的风险。
120例缺血性冠状动脉疾病患者被前瞻性随机分为接受非体外循环或体外循环手术。在术前一天和术后3个月进行详细的神经心理学评估和脑磁共振成像检查。在术后12个月重复进行神经心理学评估。
在术后新发脑病变方面，非体外循环手术（8.2%）和体外循环手术（17.3%）之间无显著差异（p = 0.17）。两组术后认知功能障碍的患病率也相似（3个月时：非体外循环组20.4%，体外循环组23.1%，p = 0.74；12个月时：非体外循环组24.1%，体外循环组23.1%，p = 0.90）。术前脑缺血损伤的程度与体外循环手术后的认知功能障碍显著相关（p = 0.02），但与非体外循环手术后无关（p = 0.22）。术前影像学检查结果正常的患者在术后3个月均未出现认知功能障碍（p = 0.04）。
非体外循环和体外循环冠状动脉搭桥手术后的长期认知功能和脑损伤的磁共振成像证据相似。术前脑磁共振成像可用于预测冠状动脉搭桥手术后认知功能障碍的风险。
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