Neurological outcome after minimally invasive coronary artery bypass surgery (NOMICS): An observational prospective cohort study.

Autor: Stessel B; Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium.; Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium., Nijs K; Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium.; Department of Anaesthesiology and Pain Medicine, University Hospital, Leuven, Belgium., Pelckmans C; Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium., Vandenbrande J; Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium., Ory JP; Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium., Yilmaz A; Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium., Starinieri P; Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium., Van Tornout M; Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium., De Klippel N; Department of Neurology, Jessa Hospital, Hasselt, Belgium., Dendale P; Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium.; Department of Cardiology, Jessa Hospital, Hasselt, Belgium.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Dec 23; Vol. 15 (12), pp. e0242519. Date of Electronic Publication: 2020 Dec 23 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0242519
Abstrakt: Background/objectives: Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimally invasive CABG procedure with retrograde arterial perfusion. The main objective of this study is to assess neurocognitive outcome after Endo-CABG.
Methods/design: In this prospective observational cohort study, patients were categorised into: Endo-CABG (n = 60), a comparative Percutaneous Coronary Intervention (PCI) group (n = 60) and a healthy volunteer group (n = 60). A clinical neurological examination was performed both pre- and postoperatively, delirium was assessed postoperatively. A battery of 6 neurocognitive tests, Quality of life (QoL) and the level of depressive feelings were measured at baseline and after 3 months. Patient Satisfaction after Endo-CABG was assessed at 3-month follow-up. Primary endpoints were incidence of postoperative cognitive dysfunction (POCD), stroke and delirium after Endo-CABG. Secondary endpoints were QOL, patient satisfaction and the incidence of depressive feelings after Endo-CABG.
Results: In total, 1 patient after Endo-CABG (1.72%) and 1 patient after PCI (1.67%) suffered from stroke during the 3-month follow-up. POCD in a patient is defined as a Reliable Change Index ≤-1.645 or Z-score ≤-1.645 in at least two tests, and was found in respectively 5 and 6 patients 3 months after Endo-CABG and PCI. Total incidence of POCD/stroke was not different (PCI: n= 7 [15.9%]; Endo-CABG: n= 6 [13.0%], p = 0.732). ICU delirium after Endo-CABG was found in 5 (8.6%) patients. QoL increased significantly three months after Endo-CABG and was comparable with QoL level after PCI and in the control group. Patient satisfaction after Endo-CABG and PCI was comparable. At follow-up, the level of depressive feelings was decreased in all groups.
Conclusions: The incidence of poor neurocognitive outcome, including stroke, POCD and postoperative ICU delirium until three months after Endo-CABG is low and comparable with PCI.
Trial Registration: Registered on ClinicalTrials.gov (NCT02979782).
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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