Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: prospective randomised controlled trial

OBJECTIVE: To assess neurocognitive impairment after the off-pump and on-pump techniques for coronary artery bypass graft surgery in patients with triple vessel disease. DESIGN: Randomised controlled trial. SETTING: University Hospital of Wales, Cardiff. PARTICIPANTS: 60 patients undergoing coronary artery bypass graft surgery for triple vessel disease prospectively randomised to the off-pump or on-pump technique. MAIN OUTCOME MEASURES: Change in scores in nine standard neuropsychometric tests administered preoperatively and at 1 and 10 weeks postoperatively. RESULTS: The on-pump group showed a significantly greater deterioration in scores for two and three tests at 1 week and 10 weeks postoperatively, respectively, than the off-pump group. The on-pump group also showed a significantly higher incidence of major deterioration in one of the tests both 1 week and 10 weeks postoperatively. The incidence of neurocognitive impairment at 1 week postoperatively was 27% (8 out of 30) in the off-pump group and 63% (19 out of 30) in the on-pump group (P=0.004); and at 10 weeks postoperatively was 10% (3 out of 30) in the off-pump group and 40% (12 out of 30) in the on-pump group (P=0.017). CONCLUSION: Off-pump coronary artery bypass graft surgery results in less neurocognitive impairment than the on-pump technique.