Neurological Complications of On-Pump versus Off-Pump Coronary Artery Bypass Graft Surgery

Background Neurological complications following cardiac surgery are serious, debilitating and, sometimes, life-threatening. Objective Assessment of neurological complications following on and off pump coronary artery bypass graft surgery. Methods We evaluated 441 consecutive patients undergoing cardiac surgery at the Service of Cardiac Surgery at the American Hospital from January 2012 October 2016. Patients were intervened following two different procedures on-pump by pass (ONCABG) surgery or off-pump bypass surgery (OPCABG). The recorded and analyzed data were as following preoperative status, including age, sex and comorbidities, intraoperative factors, including surgery type and time of surgery, duration of cardiopulmonary bypass, duration of aortic cross clamping, hypothermia, need for blood transfusions, and post operatory outcomes, including neurological complications, type and time of neurological complications, period of intensive care unit treatment. Results Of all 441 patients, 338 underwent OPCABG and 103 underwent ONCABG surgery. There were no significant differences between the groups in terms of age, gender and stroke risk factors. Nevertheless the patients undergoing ONCABG surgery presents a significantly higher prevalence of arrhythmia and prior stroke history. Moreover, more patients of the ONCABG group were treated in emergency conditions. As a result, the off-pump technique presented better neurological outcomes in terms of less stroke complications (4.4 % vs.14.6 %, pless than0.001), less encephalopathic complications (4.1 % vs.14.6 %, pless than0.001), less seizure complications (2.1 % vs.7.8 %, p=0.045) and lower in-hospital mortality (1.8 % vs.6.8 %, p=0.008). Conclusion In our observational study, the off-pump CABG surgery was associated with lower neurological complications compared to the on-pump CABG surgery