The Octopus II™ Stabilizing System: Biochemical and Neuropsychological Outcomes in Coronary Artery Bypass Surgery

(#2000-11491 ... September 25, 2000)

Robert A. Baker, PHD, Marie J. Andrew, BA (HONS), Iain K. Ross, FRACS, John L. Knight FRACS.

Cardiac Surgical Research Group, Flinders Medical Centre, South Australia, Australia

ABSTRACT

Introduction: The aim of this study was to determine if coronary artery bypass graft (CABG) surgery performed utilizing the Octopus II™ stabilizing system provides myocardial and cerebral protection comparable to traditional CABG surgery utilizing cardiopulmonary bypass (CPB).

Methods: Elective patients requiring surgery for double or triple vessel disease were randomized to receive either conventional CABG with CPB (n = 14) or OPCAB using the Octopus II™ stabilizing system (n = 12), after receiving institutional approval and written consent. Exclusion criteria included previous cardiac surgery, recent myocardial infarction, and previous cerebrovascular disease. Troponin T (TnT) was measured preoperatively and at 2, 4, 6, 8, 10, 12, 24, and 72 hours after initiation of grafting. Neuropsychological assessments (10 measures) were performed in the week prior to surgery, one week, and six months after surgery.

Results: Troponin T release was reduced in the OPCAB patients at all time points (repeated measures ANOVA p = 0.043), reaching significance at 8, 10 and 12 hours (p = 0.033, 0.038, 0.019). Other factors (composite clinical end point (prolonged LOS or ICU stay or 30-day mortality), infarction, and intubation time) did not show any significant differences between the two groups. The incidence of neuropsychological deficits was not different between the two groups at both seven-day and six-month follow-up assessments.

Conclusions: Decreased TnT release suggests a myocardial benefit for the OPCAB procedure. A neuropsychological benefit remains to be demonstrated.

AUTHOR/ARTICLE INFORMATION

Address correspondence and reprint requests to: Dr Robert A. Baker, Cardiac Surgical Research Group, Department of Cardiothoracic Surgery, Division of Medicine, Flinders Medical Centre, Bedford Park SA 5042, Australia, Phone: 61-8-8404-2015, Fax: 61-8-8404-2019, Email: Rob.Baker@flinders.edu.au

Key Words and Abbreviations: Myocardial protection, Troponin T (TnT), neuropsychological sequelae, off-pump coronary artery bypass surgery (OPCAB)