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

• Published in: PloS one 2020-12, Vol.15 (12), p.e0242519-e0242519
• Main Authors: Stessel, Björn, Nijs, Kristof, Pelckmans, Caroline, Vandenbrande, Jeroen, Ory, Jean-Paul, Yilmaz, Alaaddin, Starinieri, Pascal, Van Tornout, Michiel, De Klippel, Nina, Dendale, Paul
• Format: Article
• Language: English
• Subjects: Aged; Biology and Life Sciences; Case-Control Studies; Complications and side effects; Coronary artery bypass; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - psychology; Coronary Artery Disease - pathology; Coronary Artery Disease - psychology; Coronary Artery Disease - surgery; Delirium - etiology; Delirium - psychology; Depression - etiology; Depression - psychology; Female; Humans; Male; Medical research; Medicine and Health Sciences; Medicine, Experimental; Mental Status and Dementia Tests; Middle Aged; Neurologic manifestations of general diseases; Patient Satisfaction - statistics & numerical data; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - psychology; Prospective Studies; Quality of Life - psychology; Risk factors; Social Sciences; Stroke - etiology; Stroke - psychology; Treatment Outcome
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0242519

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. 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. 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. 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. Registered on ClinicalTrials.gov (NCT02979782).