Cognitive Outcomes in Coronary Artery Bypass Patient: Would You Like the Pump?

Lindsey, Twanda, and Joyce Conley

Coronary artery bypass surgery (CABG) is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. During surgery, the heart is usually stopped requiring a machine which mimics the function of the lungs and heart. Although, thousands of patients have undergone CABG surgery to improve their longevity, the success of CABG surgery is marred by a number of serious complications, in particular brain damage. Neurological dysfunction after coronary artery bypass online pump, results in neuropsychological dysfunction in 20% to 80% of patients. These adverse effects have been attributed to the process of cardiopulmonary bypass, because it increases micro emboli. In the belief that off pump coronary artery bypass (OPCAB), results in less adverse events, surgeons are using techniques of CABG surgery that avoid cardiopulmonary bypass.

This raised the clinical question: In heart surgery patients ages forty plus, is OPCAB, more effective than conventional CABG, in decreasing neurocognitive impairment, or preserving neurocognitive function postoperatively? A systematic appraisal of literature was conducted to acquire studies comparing neurocognitive function of patients receiving OPCAB versus CABG. The following databases: Ovid, Pubmed, Cochrane and CINAHL were searched to obtain studies regarding this information. Seven studies were retained for review. Four randomized controlled trials, one controlled trail, one blinded study, and one meta-analysis. Two studies resulted with significant difference in neurocognitive function immediately post-op, with OPCAB patients having better cognitive outcomes. However, at twelve months both groups showed similar cognitive ability. All seven studies concluded no significant difference in cognitive outcome for OPCAB versus CABG.

Although, traditional CABG surgery results in some cognitive decline initially, outcome for each patients are similar one year post-operatively. Advance practice nurses (APN) should consider which procedure is safe for patient specific condition and more cost effective when discussing options for this procedure. In addition, APNs can educat