Cognition After Cardiac Surgery
Cardiopulmonary bypass (CPB) was introduced more than five decades ago, and although there has been a dramatic reduction in both morbidity and mortality associated with this procedure, both short- and long-term cognitive impairment after coronary artery bypass grafting (CABG) continue to be significant concerns. The search for the etiology of these adverse neurocognitive outcomes has focused mainly on procedure-related factors such as embolic injury and hypoperfusion, but more recent studies have also considered patient-related factors, in particular the overall vascular burden of the patient’s brain before surgery.
Progress in our understanding of the cognitive consequences of the use of CPB has been slow for several reasons. First, the technology of CPB has been continuously evolving since its introduction, and results of studies published more than 10 years ago are therefore less applicable to the way in which CABG is being performed today. Second, the patient...
KeywordsCoronary Artery Bypass Grafting Cognitive Decline Coronary Artery Bypass Grafting Patient Postoperative Atrial Fibrillation Coronary Artery Bypass Grafting Group
This research was supported by grant 35610 from the National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD and by the Dana Foundation, New York, NY, and the Johns Hopkins Medical Institutions GCRC grant RR 00052.
We also thank the staff and participants in our study and Dr. Talalay for her editorial assistance. We are also grateful for the ongoing collaboration with Dr. W. Baumgartner as well as other participating cardiac surgeons and cardiologists.
- Bennett, H. P., Piguet, O., Grayson, D. A., Creasey, H., Waite, L. M., Broe, G. A., et al. (2003). A 6-year study of cognition and spatial function in the demented and non-demented elderly: The Sydney Older Persons Study. Dementia and Geriatric Cognitive Disorders, 16, 181–186.PubMedCrossRefGoogle Scholar
- Braekken, S. K., Reinvang, I., Russell, D., Brucher, R., & Svennevig, J. L. (1998). Association between intraoperative cerebral microembolic signals and postoperative neuropsychological deficit: Comparison between patients with cardiac valve replacement and patients with coronary artery bypass grafting. Journal of Neurology, Neurosurgery, and Psychiatry, 65, 573–576.PubMedCrossRefGoogle Scholar
- Browndyke, J. N., Moser, D. J., Cohen, R. A., O'Brien, D. J., Algina, J. J., Haynes, W. G., et al. (2002). Acute neuropsychological functioning following cardiosurgical interventions associated with the production of intraoperative cerebral microemboli. Clinical Neuropsychologist, 16, 463–471.PubMedCrossRefGoogle Scholar
- Floyd, T. F., Shah, P. N., Price, C. C., Harris, F., Ratcliffe, S. J., Acker, M. A., et al. (2006). Clinically silent cerebral ischemic events after cardiac surgery: Their incidence, regional vascular occurrence, and procedural dependence. Annals of Thoracic Surgery, 81, 2160–2166.PubMedCrossRefGoogle Scholar
- Goto, T., Baba, T., Honma, K., Shibata, Y., Arai, Y., Uozumi, H., et al. (2001a). Magnetic resonance imaging findings and postoperative neurologic dysfunction in elderly patients undergoing coronary artery bypass grafting. Annals of Thoracic Surgery, 72, 137–142.Google Scholar
- Goto, T., Baba, T., Honma, K., Shibata, Y., Arai, Y., Uozumi, H., et al. (2001b). Magnetic resonance imaging findings and postoperative neurologic dysfunction in elderly patients undergoing coronary artery bypass grafting. Annals of Thoracic Surgery, 72, 137–142.Google Scholar
- Hlatky, M. A., Bacon, C., Boothroyd, D., Mahanna, E., Reves, J. G., Newman, M. F., et al. (1999). Cognitive function 5 years after randomization to coronary angioplasty or coronary artery bypass graft surgery. Circulation, 96(Suppl. II), 11–15.Google Scholar
- Ho, P. M., Arciniegas, D. B., Grigsby, J., McCarthy, M., Jr., McDonald, G. O., Moritz, T. E., et al. (2004). Predictors of cognitive decline following coronary artery bypass graft surgery. Annals of Thoracic Surgery, 77, 597–603.Google Scholar
- Knipp, S. C., Matatko, N., Schlamann, M., Wilhelm, H., Thielmann, M., Forsting, M., et al. (2005). Small ischemic brain lesions after cardiac valve replacement detected by diffusion-weighted magnetic resonance imaging: Relation to neurocognitive function. European Journal of Cardio-Thoracic Surgery, 28, 88–96.PubMedCrossRefGoogle Scholar
- Rasmussen, L. S., Johnson, T., Kuipers, H. M., Kristensen, D., Siersma, V. D., Vila, P., et al. (2003). Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiologica Scandinavica, 47, 260–266.PubMedCrossRefGoogle Scholar
- Rosengart, T. K., Sweet, J., Finnin, E. B., Wolfe, P., Cashy, J., Hahn, E., et al. (2005). Neurocognitive functioning in patients undergoing coronary artery bypass graft surgery or percutaneous coronary intervention: Evidence of impairment before intervention compared with normal controls. Annals of Thoracic Surgery, 80, 1327–1334.PubMedCrossRefGoogle Scholar
- Selnes, O. A., Grega, M. A., Borowicz, L. M., Jr., Royall, R. M., McKhann, G. M., & Baumgartner, W. A. (2003). Cognitive changes with coronary artery disease: A prospective study of coronary artery bypass graft patients and nonsurgical controls. Annals of Thoracic Surgery, 75, 1377–1384.Google Scholar
- Selnes, O. A., Royall, R. M., Grega, M. A., Borowicz, L. M., Jr., Quaskey, S., & McKhann, G. M. (2001). Cognitive changes 5 years after coronary artery bypass grafting: Is there evidence of late decline? Archives of Neurology, 58, 598–604.Google Scholar
- Zamvar, V., Williams, D., Hall, J., Payne, N., Cann, C., Young, K., et al. (2002). Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: Prospective randomised controlled trial. British Medical Journal, 325, 1268–1271.PubMedCrossRefGoogle Scholar