Cognitive outcome after off-pump and on-pump Coronary artery bypass graft surgery a Randomized trial
Diederik van Dijk,Erik W.L. Jansen,Ron Hijman,Arno P. Nierich,Jan C. Diephuis,Karel G.M. Moons,Jaap R. Lahpor,Cornelius Borst,Annemieke M. A. Keizer,Hendrik M. Nathoe,Diederick E. Grobbee,Peter de Jaegere,Cor J. Kalkman +12 more
TLDR
Patients who received their first CABG surgery without cardiopulmonary bypass had improved cognitive outcomes 3 months after the procedure, but the effects were limited and became negligible at 12 months.Abstract:
ContextCoronary artery bypass graft (CABG) surgery is associated with a decline
in cognitive function, which has largely been attributed to the use of cardiopulmonary
bypass (on-pump procedures) Cardiac stabilizers facilitate CABG surgery without
use of cardiopulmonary bypass (off-pump procedures) and should reduce the
cognitive decline associated with on-pump proceduresObjectiveTo compare the effect of CABG surgery with (on-pump) and without (off-pump)
cardiopulmonary bypass on cognitive outcomeDesign and SettingRandomized controlled trial conducted in the Netherlands of CABG surgery
patients enrolled from March 1998 through August 2000, with 3- and 12-month
follow-upParticipants and InterventionPatients scheduled for their first CABG surgery (mean age, 61 years;
n = 281) were randomly assigned to off-pump surgery (n = 142) or on-pump surgery
(n = 139)Main Outcome MeasuresCognitive outcome at 3 and 12 months, which was determined by psychologists
(blinded for randomization) who administered 10 neuropsychological tests before
and after surgery Quality of life, stroke rate, and all-cause mortality at
3 and 12 months were secondary outcome measuresResultsCognitive outcome could be determined at 3 months in 248 patients Cognitive
decline occurred in 21% in the off-pump group and 29% in the on-pump group
(relative risk [RR], 065; 95% confidence interval [CI], 036-116; P = 15) The overall standardized change score (ie, improvement
of cognitive performance) was 019 in the off-pump vs 013 in the on-pump
group (P = 03) At 12 months, cognitive decline
occurred in 308% in the off-pump group and 336% in the on-pump group (RR,
088; 95% CI, 052-149; P = 69) The overall standardized
change score was 019 in the off-pump vs 012 in the on-pump group (P = 09) No statistically significant differences were
observed between the on-pump and off-pump groups in quality of life, stroke
rate, or all-cause mortality at 3 and 12 monthsConclusionPatients who received their first CABG surgery without cardiopulmonary
bypass had improved cognitive outcomes 3 months after the procedure, but the
effects were limited and became negligible at 12 monthsread more
Citations
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Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document.
A. Pieter Kappetein,Stuart J. Head,Philippe Généreux,Nicolo Piazza,Nicolas M. Van Mieghem,Eugene H. Blackstone,Thomas G. Brott,David J. Cohen,Donald E. Cutlip,Gerrit Anne van Es,Rebecca T. Hahn,Ajay J. Kirtane,Mitchell W. Krucoff,Susheel Kodali,Michael J. Mack,Roxana Mehran,Josep Rodés-Cabau,Pascal Vranckx,John G. Webb,Stephan Windecker,Patrick W. Serruys,Martin B. Leon +21 more
TL;DR: This VARC-2 document has provided further standardization of endpoint definitions for studies evaluating the use of TAVI, which will lead to improved comparability and interpretability of the study results, supplying an increasingly growing body of evidence with respect to TAVi and/or surgical aortic valve replacement.
Journal ArticleDOI
Updated Standardized Endpoint Definitions for Transcatheter Aortic Valve Implantation
A. Pieter Kappetein,Stuart J. Head,Philippe Généreux,Nicolo Piazza,Nicolas M. Van Mieghem,Eugene H. Blackstone,Thomas G. Brott,David Cohen,Donald E. Cutlip,Gerrit-Anne van Es,Rebecca T. Hahn,Ajay J. Kirtane,Mitchell W. Krucoff,Susheel Kodali,Michael J. Mack,Roxana Mehran,Josep Rodés-Cabau,Pascal Vranckx,John G. Webb,Stephan Windecker,Patrick W. Serruys,Martin B. Leon +21 more
TL;DR: This VARC-2 document has provided further standardization of endpoint definitions for studies evaluating the use of TAVI, which will lead to improved comparability and interpretability of the study results, supplying an increasingly growing body of evidence with respect to TAVi and/or surgical aortic valve replacement.
Journal ArticleDOI
ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: Summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to update the 1999 guidelines for coronary artery bypass graft surgery)
Kim A. Eagle,Robert A. Guyton,Ravin Davidoff,Fred H. Edwards,Gordon A. Ewy,Timothy J. Gardner,James C. Hart,Howard C. Herrmann,L. David Hillis,Adolph M. Hutter,Bruce W. Lytle,Robert A. Marlow,William C. Nugent,Thomas A. Orszulak,Elliott M. Antman,Sidney C. Smith,Joseph S. Alpert,Jeffrey L. Anderson,David P. Faxon,Valentin Fuster,Raymond J. Gibbons,Gabriel Gregoratos,Jonathan L. Halperin,Loren F. Hiratzka,Sharon A. Hunt,Alice K. Jacobs,Joseph P. Ornato +26 more
TL;DR: The major areas of change reflected in the update of the ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery are described in a format that can be read and understood as a stand-alone document.
Journal ArticleDOI
Off-pump vs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial.
John D. Puskas,Willis H. Williams,Elizabeth M. Mahoney,Philip R. Huber,Peter C. Block,Peggy G. Duke,James R. Staples,Katherine E. Glas,J. Jeffrey Marshall,Mark E. Leimbach,Susan A. McCall,Rebecca Petersen,Dianne E. Bailey,William S. Weintraub,Robert A. Guyton +14 more
TL;DR: In this article, the authors evaluated graft patency, clinical and quality-of-life outcomes, and cost among patients while in the hospital and at 1-year follow-up.
Journal ArticleDOI
Postoperative cognitive dysfunction after noncardiac surgery: a systematic review.
TL;DR: A systematic review on the research into postoperative cognitive dysfunction (POCD) in noncardiac surgery to ascertain the status of the evidence and to examine the methodologies used in studies is presented in this article.
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