Neurological, Cognitive, and Psychiatric Sequelae Associated with the Surgical Management of Cardiac Disease

Abstract

In dramatic contrast to some areas of the world where cardiovascular disease is nearly nonexistant, as exemplified by the Massai tribe in Kenya, the incidence and prevalence of cardiovascular disease has, until very recently, experienced a spiraling increase in populations in the Western world. In the United States, about 650,000 persons succumb to death from coronary heart disease annually, and rates of new and recurrent myocardial infarctions per year have been estimated to be approximately 1 million based on data from the National Health Survey and the Framingham Heart Study. There currently appears to be a new trend toward a decline in mortality from cardiovascular disease that has probably resulted from a combination of factors, including an increased public awareness of risk factors that have been shown to result in the development of the disease; reduction of some or as many as possible of these risk factors with accompanying modification of life-style (e.g., cessation of smoking); earlier detection and improved treatment and control of hypertension, diabetes, hyperlipidemia, and obesity; rapid advances in pharmacology that have resulted in important new drugs that have drastically improved the efficacy and safety of medical management of coronary artery disease; rapid advancement and achievement in surgical techniques to palliatively correct the anatomical and physiological pathology; and scientific advances that have served to augment the overall success of the surgery in terms of myocardial preservation, cerebral protection, and reduction in operative mortality and postoperative morbidity. The effects on survival of recent, encouraging short-term success with a less invasive new procedure—percutaneous transluminal coronary angioplasty—are as yet unknown.