Coronary artery bypass performed without the use of cardiopulmonary bypassis associated with reduced cerebral microemboli and improved clinical results

Study objectives: Strokes and neurocognitive dysfunction have been correlat ed with cerebral microemboli produced during cardiopulmonary bypass (CPB), The purpose of this study was to determine whether, and to what extent, off -pump coronary artery bypass (OPCAB) reduces the occurrence of cerebral mic roemboli compared with traditional coronary artery bypass grafting (CABG) w ith CPB and to compare clinical results. Design and patients: A retrospective review of 137 patients undergoing elec tive CABG was performed, 70 of whom underwent traditional CABG and 67 of wh om underwent OPCAB. Using transcranial Doppler ultrasonography, 40 patients (20 CABG, 20 OPCAB) were continuously monitored intraoperatively for the o ccurrence and pattern of cerebral microemboli. Setting: Private, university-affiliated tertiary care hospitals. Results: There was no statistical difference in the age, sex, or underlying comorbidities between those patients undergoing CABG and OPCAB, CABG patie nts did have a slightly lower preoperative ejection fraction (50.9% vs 55.5 %, p = 0.03). Despite these similar preoperative characteristics, the OPCAB group experienced significant reductions in cerebral microemboli (27 vs 1, 766, p = 0.003), transfusion requirements (29.9% vs 47.1%, p = 0.04), intub ation time (3.3 vs 9.5 h, p < 0.001), ICU length of stay (1.5 vs 2.8 days, p = 0.02), and overall hospitalization (4.9 vs 6.6 days, p = 0.01) without an increase in mortality. Fewer strokes and deaths were observed in the OPC AB group, but these trends failed to reach statistical significance. Conclusions: In similar patient populations, OPCAB was associated with sign ificantly fewer cerebral microemboli and improved clinical results without an increase in mortality. We believe that these early results support OPCAB as a viable and potentially safer alternative to traditional CABG.