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(Circulation. 2002;105:e179.)
© 2002 American Heart Association, Inc.

Correspondence

Neuropsychological Outcome After Off-Pump Versus On-Pump Coronary Bypass Surgery: the Octopus Randomized Trial

Diederik van Dijk, MD

University Medical Center Utrecht, Department of Anesthesiology, Utrecht, The Netherlands

Peter P.T. de Jaegere, MD, PhD

University Medical Center Utrecht, Department of Cardiology, Utrecht, The Netherlands, E-mail p.p.t.dejaegere@hli.azu.nl

To the Editor:

In the October 9, 2001 issue of Circulation, Dr Yacoub provides editorial comments¹ on the 1-month outcome of the Octopus Study, published in the same issue.² In this study, patients referred for bypass operation were randomized to either off- or on-pump surgery. Dr Yacoub cites from our study that there were no differences in cardiac outcome, quality of life, and neurological outcome between the 2 groups. He also states, unfortunately, that no differences were found in neuropsychological outcome. This, however, was not evaluated at 1 month after surgery. In the Octopus Trial, neuropsychological testing was carried out 3 and 12 months after the operation. The neuropsychological outcome at 3 months is the primary endpoint of this trial and was recently published.³

References

1. Yacoub M. Off-pump coronary bypass surgery: in search of an identity. Circulation. 2001; 104: 1743–1745.[Free Full Text]
   
2. Van Dijk D, Nierich AP, Jansen EWL, et al. Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation. 2001; 104: 1761–1766.[Abstract/Free Full Text]
   
3. Van Dijk D, Jansen EW, Hijman R, et al. Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial. JAMA. 2002; 287: 1405–1412.[Abstract/Free Full Text]
   

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Response

Magdi Yacoub, FRS

Professor of Cardiothoracic Surgery, Imperial College of Science, Technology, and Medicine, London, England

The report by van Dijk and colleagues¹ represents a nearly complete assessment of off-pump coronary bypass surgery in a randomized trial. Their postoperative assessment did include neurological examination by an independent assessor as well as psychological assessment through the two "quality of life" questionnaires. They reported "no differences in" what I considered to be "neuropsychological outcome." Their intention to report later changes in these or other parameters is welcome. It is hoped that they will also clarify the criteria for inclusion and the percentage of usage of OPCAB. As stressed in the editorial,² reports on the "late" outcome of patients in these and other randomized trials should be extremely valuable and are eagerly awaited.

References

1. Van Dijk D, Nierich AP, Jansen EWL, et al. Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation. 2001; 104: 1761–1766.
   
2. Yacoub M. Off-pump coronary bypass surgery: in search of an identity. Circulation. 2001; 104: 1743–1745.
   

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