Longitudinal Assessment of Neurocognitive Function after Coronary-Artery Bypass Surgery
Mark F. Newman, M.D., Jerry L. Kirchner, B.S., Barbara Phillips-Bute, Ph.D., Vincent Gaver, B.S., Hilary Grocott, M.D., Robert H. Jones, M.D., Daniel B. Mark, M.D., Joseph G. Reves, M.D., James A. Blumenthal, Ph.D., for The Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators
Background Cognitive decline complicates early recovery aftercoronary-artery bypass grafting (CABG) and may be evident inas many as three quarters of patients at the time of dischargefrom the hospital and a third of patients after six months.We sought to determine the course of cognitive change duringthe five years after CABG and the effect of perioperative declineon long-term cognitive function.
Methods In 261 patients who underwent CABG, neurocognitive testswere performed preoperatively (at base line), before discharge,and six weeks, six months, and five years after CABG surgery.Decline in postoperative function was defined as a drop of 1SD or more in the scores on tests of any one of four domainsof cognitive function. (A reduction of 1 SD represents a declinein function of approximately 20 percent.) Overall neurocognitivestatus was assessed with a composite cognitive index score representingthe sum of the scores for the individual domains. Factors predictinglong-term cognitive decline were determined by multivariablelogistic and linear regression.
Results Among the patients studied, the incidence of cognitivedecline was 53 percent at discharge, 36 percent at six weeks,24 percent at six months, and 42 percent at five years. We investigatedpredictors of cognitive decline at five years and found thatcognitive function at discharge was a significant predictorof long-term function (P<0.001).
Conclusions These results confirm the relatively high prevalenceand persistence of cognitive decline after CABG and suggesta pattern of early improvement followed by a later decline thatis predicted by the presence of early postoperative cognitivedecline. Interventions to prevent or reduce short- and long-termcognitive decline after cardiac surgery are warranted.
Cognitive decline has increasingly been recognized as a complicationafter cardiac surgery. Although important advances in techniquesfor perioperative anesthesia, surgery, and the protection oforgans have resulted in substantial reductions in age-adjustedand risk-adjusted mortality,1 the incidence of cognitive declinehas changed little over the past 15 years. Elderly patientswith multiple health problems, who are at higher risk than othergroups of patients for neurologic and neurocognitive problems,are now able to undergo surgical procedures relatively latein life without serious concern about loss of life. However,they are at substantially increased risk for central nervoussystem dysfunction and, in particular, cognitive decline aftersurgery.2,3,4,5 The clinical and financial implications of theseproblems can be profound, since prolonged hospitalization andan increased use of resources are associated with major andeven minor neurobehavioral declines.6,7
Many clinicians have minimized the importance of perioperativecognitive decline, because the decline appears to be transientin a substantial number of patients. The incidence of impairmentis related to the time that has elapsed between cardiac surgeryand the assessment of cognitive function. The incidence of declineis highest at discharge (when it is approximately 50 to 80 percent);it is 20 to 50 percent at six weeks and 10 to 30 percent atsix months.5,8,9,10 Despite this substantial rate of persistentdecline, many have questioned the importance of cognitive deteriorationwith regard to long-term outcome for patients.
We undertook a prospective investigation to determine the effectof perioperative cognitive deterioration on longer-term cognitivefunction by following cognitive function longitudinally forfive years after cardiac surgery.
Methods
Enrollment of Patients
After approval was obtained from the institutional review board,261 patients undergoing elective coronary-artery bypass grafting(CABG) gave their written informed consent and were enrolledin the study. Patients who had a history of symptomatic cerebrovasculardisease (with residual deficit), psychiatric illness, renaldisease (indicated by a serum creatinine concentration higherthan 2.0 mg per deciliter [177 µmol per liter]), or activeliver disease, who had less than a seventh-grade education,or who could not read were excluded.
Measurement of Neurocognitive Function
A brief battery of neurocognitive tests was administered beforesurgery (at base line), on the day before discharge (approximatelyseven days after CABG), and six weeks, six months, and fiveyears after CABG (Figure 1). Assessments were performed individuallyby experienced psychometricians using a well-validated batterythat included five tests. The short-story module of the RandtMemory Test requires subjects to recall the details of a shortstory immediately after it is read to them and after a 30-minutedelay. Scoring is based on both the ability of the subject torecall the story verbatim and the ability to capture its giston immediate and delayed testing (resulting in four variablescores ranging from 0 to 10 or 0 to 20, with higher scores indicatingbetter function).11 The Digit Span subtest of the Wechsler AdultIntelligence Scale–Revised requires subjects, first, torepeat in numerical order a series of digits that has been presentedto them orally and then, in an independent test, to repeat thedigits in reverse order (resulting in two variable scores rangingfrom 0 to 14, with higher scores indicating better function).12The Benton Revised Visual Retention Test requires subjects toreproduce from memory a series of geometric shapes after a 10-secondexposure (resulting in one variable score ranging from 0 to10, with a higher score indicating better function).13 The DigitSymbol subtest of the Wechsler Adult Intelligence Scale–Revisedis a task that requires subjects to reproduce on paper, within90 seconds, as many coded symbols as possible in blank boxesbeneath randomly generated digits, according to a coding schemefor pairing digits with symbols (for one variable score rangingfrom 0 to 90, with a higher score indicating better function).12The Trail Making Test (Part B) requires subjects to connectwith a line, as quickly as possible, a series of numbers andletters in sequence (e.g., 1–A–2–B) (for onevariable score ranging from 1 to 300, with a lower score indicatingbetter function).14
Patient enrollment began in March 1989 and ended in November 1993. Discharge testing was conducted between 5 and 15 days after surgery, 6-week testing 4 to 6 weeks after surgery, 6-month testing 5 to 8 months after surgery, and 5-year testing 4.4 to 5.4 years after surgery.
Treatment of Patients during Cardiac Surgery
Anesthetic management with midazolam, fentanyl, vecuronium,and a perfusion apparatus has been previously described.2 Nonpulsatileperfusion of 2 to 2.4 liters per minute per square meter ofbody-surface area was maintained throughout cardiopulmonarybypass. The pump was primed with crystalloid solution designedto achieve a hematocrit of 18 percent or higher during extracorporealcirculation. Packed red cells were added when necessary to achievethe desired hematocrit. Cardiopulmonary bypass was institutedthrough cannulation of the ascending aorta in all patients.Arterial carbon dioxide tension was maintained at 35 to 40 mmHg (uncorrected for temperature) throughout the cardiopulmonary-bypassprocedure, and the partial pressure of oxygen was maintainedat 150 to 250 mm Hg.
Statistical Analysis
To assess neurocognitive function over time while minimizingthe potential for redundancy in the neurocognitive measures,a factor analysis with orthogonal rotation (a linear transformationused to make the results of the factor analysis easier to interpret)was first performed on the base-line scores on the nine individualneurocognitive tests. This analysis included all 261 enrolledpatients. Factor analysis was used to reduce the larger numberof correlated dependent variables to a smaller number of uncorrelatedoutcome variables to be used in the final analysis. The factorloadings (weights) of each test on each factor were used toconstruct comparable domain scores at each of the follow-upevaluations, on the basis of the patients' test scores at thattime. Thus, the domains (areas tested) were identified at baseline and remained consistent throughout follow-up. Because thefactors were not correlated with each other, type I errors dueto multiple comparisons were minimized. The use of factors insteadof the individual scores as the outcomes in subsequent analysesalso eliminated concern about the redundancy of tests and thepossibility of overrepresenting a single domain of cognitivefunctioning.
Factor analysis of the base-line scores on the nine neuropsychologicaltests suggests that four factors accounted for 86 percent ofthe variance among patients' base-line results on our batteryof tests. The four factors represent the cognitive domains ofverbal memory and language comprehension (short-term and delayed);abstraction and visuospatial orientation; attention, psychomotorprocessing speed, and concentration; and visual memory. We calculatedthe change in score for each of the factors by subtracting thebase-line scores for that factor from the follow-up scores forthat factor. Cognitive decline was defined as a decline of 1SD in performance in any one of the four domains (the standarddeviation was equal to the cross-sectional standard deviationof the base-line scores for the relevant factor).
To assess overall cognitive function and the degree of learning(improvement due to practice, reflecting repeated exposure tothe testing procedures) or cognitive decline across all domains,we calculated a composite cognitive index by adding the fourdomain scores to yield a single, continuous measure of cognitivefunction. This summary measure was used to control for base-linefunction in multivariable models and included improvement aswell as decline.
Predictors of the presence or absence of cognitive decline (asa dichotomous outcome) were investigated by means of logistic-regressionanalysis. Predictors of change in the composite cognitive indexwere investigated by means of a linear regression model. Whenpatients were unable to complete one or two of the nine testsor subtests at base line or at follow-up, we included data inthe analysis for the tests they did not complete by imputingvalues on the basis of a regression equation incorporating theavailable values. Data for patients with more than two missingscores were not included in the analysis. However, to ensurethat the exclusion of data for patients who were unable to completethe five-year follow-up evaluation because they had died orhad had a stroke did not bias our results with respect to theeffect of early decline on long-term function, we repeated ouranalysis after imputing worst-case scores for these patients.
Results
A total of 261 patients were enrolled in the study at the DukeHeart Center from March 1989 through November 1993, and finalfive-year follow-up was completed in November 1998. Characteristicsof the patients, including age, sex, race, years of education,duration of cardiopulmonary bypass, duration of aortic cross-clamping,and medical conditions are listed in Table 1. Of the original261 patients, 172 were available for follow-up at five yearsand completed the postoperative testing at the earlier times.Comparison of the demographic and clinical characteristics ofthe patients who completed follow-up with the characteristicsof those who did not indicated that the latter were more likelyto have American Society of Anesthesiologists (ASA) class IVrisk, to have had a previous myocardial infarction, and to havea history of symptomatic neurologic events (Table 1). The reasonsfor loss to follow-up (in 89 patients) were our inability tocontact the patient (30 patients [34 percent]), death (23 patients[26 percent]), health problems (14 patients [16 percent]), lackof interest (8 patients [9 percent]), lack of transportation(5 patients [6 percent]), and other reasons (9 patients [10percent]).
The mean scores on the neurocognitive tests at base line andat the four follow-up evaluations are presented in Table 2.Cognitive decline was evident in 53 percent of the patientsat discharge; the incidence decreased to 36 percent at six weeksand 24 percent at six months. Five years after surgery, theincidence of cognitive decline was 42 percent. The inclusionof worst-case scores for patients who were unable to completetesting as a result of death or debilitating stroke changedthe incidence of decline only minimally.
Table 2. Scores on Tests of Neurocognitive Function at the Five Testing Points.
The composite cognitive index showed a similar gradual improvementup to six months, both in patients who had early postoperativecognitive decline and in those who did not (Figure 2). In patientswithout evidence of early postoperative decline, the compositecognitive index score at five years returned to a value nearits base-line level after having shown a learning effect betweensix weeks and six months. In contrast, the composite cognitiveindex score of patients who had early postoperative cognitiveimpairment declined below base-line levels to a level similarto that assessed at discharge (Figure 2). Data on the patientswho died or had strokes are not included in Figure 2.
Figure 2. Composite Cognitive Index as a Function of Cognitive Impairment at Discharge.
The composite cognitive index is the sum of the scores for the four domains and includes cognitive decline as well as increases in scores as a result of learning. Positive change represents an overall improvement (learning), whereas negative values indicate overall decline. The I bars represent the standard error.
Predictors of Cognitive Decline at Five Years
To determine which demographic and perioperative factors wereassociated with cognitive decline at five years, suspected univariablepredictors of cognitive decline were assessed by means of logisticregression (Table 3). Significant univariable predictors includedolder age, lower level of education, and evidence of cognitivedecline at discharge. Predictors found to be significant inthe univariable analysis were included in a multivariable analysisassessing predictors of cognitive decline. All three univariablepredictors, including cognitive decline measured at discharge(P=0.03), remained significant in the multivariable analysispredicting long-term cognitive decline at five years. The inclusionof data for the patients who died or had strokes did not appreciablychange the predictors or their significance.
Table 3. Univariable and Multivariable Predictors of Cognitive Decline and Change in the Composite Cognitive Index at Five Years.
Predictors of the Composite Cognitive Index
In addition to predictors of the incidence of cognitive decline,we also assessed the factors predicting the level of function(composite cognitive index) at five years, using univariablelinear regression followed by multivariable linear regression(Table 3). Independent predictors of the decline in the compositecognitive index at five years included older age, lower levelof education, higher base-line score for cognitive function,and presence of cognitive decline at discharge. Lower base-linescores are constrained by a "basement" effect: they leave asmaller range for decline than do higher scores. A comparisonof patients' composite cognitive index according to the presenceor absence of impairment at discharge (Figure 2) showed a gradualimprovement in overall cognitive function in both the patientswith cognitive impairment and those without impairment, withfunction returning to or near the base-line level at six months.However, whereas the function of patients without cognitiveimpairment at discharge remained above the base-line level fiveyears after surgery, that of patients who had impairment atdischarge showed a marked decline from base-line function fiveyears later. This association between perioperative cognitivedecline and long-term cognitive decline remained significanteven after we controlled for factors such as age, educationallevel, and base-line score in the multivariable model (P<0.001)(Table 3).
Discussion
The results of this investigation further define the effectof perioperative cognitive decline on long-term cognitive function.Patients whose cognitive function declines immediately aftersurgery (approximately 50 percent of patients who undergo CABG)are at increased risk for long-term cognitive decline and areduced level of overall cognitive functioning. Our work inassessing the longitudinal effects of cardiac surgery on cognitivefunctioning extends that of Sotaniemi et al.15 and Murkin etal.10 by using a larger sample and a longer period of follow-up.The change that occurred between base line and five years aftersurgery in the patients in our study who showed a cognitivedecline at discharge was more than two to three times that demonstratedin a longitudinal assessment of cognitive function in 5888 Medicarepatients who were followed for five years.16 Adjectives suchas "subtle," "transient," and "subclinical" have been used todescribe the cognitive decline that occurs after CABG, but suchdescriptions minimize the importance of these changes to clinicians,patients, and their families. The results of our study indicatethat early cognitive impairment is clinically significant andis a harbinger of later cognitive impairment.
The methods we used to define cognitive decline were chosenon the basis of our previous studies and recommendations fromconsensus statements on the assessment of neurobehavioral outcomeafter cardiac surgery.17,18 We used factor analysis to minimizethe redundancy of tests and potential type I errors. The factorloadings represented four recognized domains of cognitive function,and these domains were identified and defined at base line andremained consistent at the follow-up time points. This modelallowed us to compare the change from base line in the cognitivefunction of different patients by determining whether therewas a change of 1 SD or more in any of the domains at any ofthe times, as recommended by the consensus statement on cognitivedysfunction after surgery.17,18 It also allowed us to assesslearning by means of the composite cognitive index, the sumof the four domain scores. A downward change of 1 SD in a domainof cognition indicates a reduction of approximately 20 percentin cognitive function in that domain. To put this in context,on a test such as the Digit Symbol subtest, for which good age-relatednormative data exist, a 20 percent decline is similar to thedifference in function between 40- and 60-year-old subjects.More information is needed to determine the importance of thesechanges to real-world behavior.
To understand better the demographic and perioperative factorsassociated with cognitive change, we assessed a number of factorsthat we and others have identified as significant predictorsof cognitive decline after surgery.9 Multivariable analysisidentified older age, higher base-line neurocognitive function,lower educational level, and cognitive decline at dischargeas predictors of long-term (five-year) cognitive decline. Anumber of demographic and perioperative variables were not significantpredictors of long-term decline; these included sex, durationof cardiopulmonary bypass, and duration of aortic cross-clamping.The left ventricular ejection fraction did approach significancein the multivariable assessment of predictors of the compositecognitive index, indicating that patients with cardiac dysfunctionmay be at increased risk for overall cognitive decline aftercardiac surgery. With a larger sample, left ventricular ejectionfraction might have been a significant factor affecting long-termdecline. The inclusion of patients who died or had strokes beforethe scheduled testing at five years did not substantially changethe predictors of cognitive decline or their significance.
The consistency of the predictors of cognitive decline and thecomposite cognitive index indicates the stability of our model,in which age, educational level, and the presence or absenceof perioperative cognitive decline consistently predicted thelevel of long-term cognitive function. The degree of protectionprovided by higher levels of education is similar to that foundpreviously.2 Given that higher levels of education also "protect"patients from the progression of Alzheimer's disease,19 themechanism of this protection may be an ability to compensatefor acquired cognitive difficulties, or it may be some morecomplex central mechanism.
Our study is limited by the loss to follow-up that is inevitablein a longitudinal study in which patients are followed for fiveyears. Statistical comparisons were made between the patientswho completed follow-up and those who did not; these data areshown in Table 1. Patients who did not complete follow-up weremore likely to have ASA class IV risk (indicating a high levelof coexisting conditions), to have had a previous myocardialinfarction, and to have a history of symptomatic neurologicdisease. The addition of data for the patients who died beforethe five-year follow-up assessment narrowed this differencebut did not change the results of the trial. This selectiveattrition of high-risk patients suggests that the overall incidenceof cognitive decline may underestimate the persistent declinedemonstrated at each of the follow-up visits. In order to includeas much data as possible, we gave patients who were unable tocomplete the testing at five years because of death or strokea worst-case score for cognitive function, and we then analyzedthe data with and without these patients included. The inclusionof these patients produced only minimal changes in the calculatedincidence of dysfunction and no difference in the predictorsof long-term cognitive decline.
Our data demonstrate a significant association between cognitivedecline immediately after CABG surgery and both the incidenceand the severity of cognitive decline five years later. Thisassociation indicates that because of perioperative injury,increased susceptibility to such injury, or decreased abilityto recover from it, patients with perioperative decline areat increased risk for long-term cognitive decline. Determininghow this decline compares with any changes in cognitive functionthat occur in a population of similar age and state of healthwho have not undergone CABG would require a prospective longitudinalstudy that included the latter group. Studies of elderly subjectshave demonstrated a gradual decline in neurocognitive functionwith age.15,20,21,22 In most investigations, genetic and environmentalfactors have been shown to interact to affect the progressionof cognitive decline related to aging. Our data indicate thatcardiac surgery with cardiopulmonary bypass is an additionalfactor that can alter this progression.
Further investigation of the effects of cognitive change onthe quality of life of patients who have undergone CABG surgeryis essential. The effect of short- and long-term neurocognitivedecline on the quality of life after cardiac surgery is thesubject of an ongoing debate. In the context of a number ofmedical situations, including chronic obstructive pulmonarydisease,23 repair of abdominal aortic aneurysm,24 neurosurgery,25and cardiac rehabilitation,26 substantial change in cognitivefunction is associated with changes in the quality of life.These findings are consistent with our earlier results, whichshowed a significant correlation between cognitive functionand quality of life after cardiac surgery.27 This analysis ispreliminary, but if our findings hold true after further scrutiny,they underscore the importance of preventing or reducing perioperativecognitive decline in order to preserve long-term cognitive functionand the quality of life in the growing population of elderlypatients undergoing cardiac surgery. Patients in whom earlypostoperative cognitive decline is identified may be candidatesfor aggressive intervention strategies to prevent the late cognitivedeterioration we have documented.
Supported in part by grants (RO1-AG09663 and 1R01HL54316) fromthe National Institutes of Health and by a grant-in-aid (95010970)from the American Heart Association.
* The members of the study groups are listed in the Appendix.
Source Information
From the Department of Anesthesiology (M.F.N., J.L.K., B.P.-B., V.G., H.G., J.G.R.), the Department of Surgery (R.H.J.), the Division of Cardiology (D.B.M.), and the Department of Psychiatry and Behavioral Science (J.A.B.), Duke University Medical Center, Durham, N.C.
Address reprint requests to Dr. Newman at the Division of Cardiothoracic Anesthesia, Box 3094, Duke University Medical Center, Durham, NC 27710, or at newma005{at}mc.duke.edu.
References
Jones EL, Weintraub WS, Craver JM, Guyton RA, Cohen CL. Coronary bypass surgery: is the operation different today? J Thorac Cardiovasc Surg 1991;101:108-115. [Abstract]
Newman MF, Croughwell ND, Blumenthal JA, et al. Effect of aging on cerebral autoregulation during cardiopulmonary bypass: association with postoperative cognitive dysfunction. Circulation 1994;90:Suppl II:II-243-II-249.
Tuman KJ, McCarthy RJ, Najafi H, Ivankovich AD. Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations. J Thorac Cardiovasc Surg 1992;104:1510-1517. [Abstract]
Hammon JW Jr, Stump DA, Kon ND, et al. Risk factors and solutions for the development of neurobehavioral changes after coronary artery bypass grafting. Ann Thorac Surg 1997;63:1613-1618. [Free Full Text]
Weintraub WS, Jones EL, Craver J, Guyton R, Cohen C. Determinants of prolonged length of hospital stay after coronary bypass surgery. Circulation 1989;80:276-284. [Free Full Text]
Roach GW, Kanchuger M, Mangano CM, et al. Adverse cerebral outcomes after coronary bypass surgery. N Engl J Med 1996;335:1857-1863. [Free Full Text]
Blumenthal JA, Mahanna EP, Madden DJ, White WD, Croughwell ND, Newman MF. Methodological issues in the assessment of neuropsychologic function after cardiac surgery. Ann Thorac Surg 1995;59:1345-1350. [Free Full Text]
Newman MF, Croughwell ND, Blumenthal JA, et al. Predictors of cognitive decline after cardiac operation. Ann Thorac Surg 1995;59:1326-1330. [Free Full Text]
Murkin JM, Baird DL, Martzke JS, Adams SJ, Lok P. Long-term neurological and neuropsychological outcome 3 years after coronary artery bypass surgery. Anesth Analg 1996;82:Suppl:S328-S328.abstract
Randt C, Brown E. Administration manual: Randt Memory Test. New York: Life Sciences, 1983.
Wechsler D. The Wechsler Adult Intelligence Scale-Revised (WAIS-R). San Antonio, Tex.: Psychological Corporation, 1981.
Benton AL, Hansher K. Multilingual aphasia examination. Iowa City: University of Iowa Press, 1978.
Reitan RM. Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills 1958;8:271-276.
Sotaniemi KA, Mononen H, Hokkanen TE. Long-term cerebral outcome after open-heart surgery: a five-year neuropsychological follow-up study. Stroke 1986;17:410-416. [Free Full Text]
Haan MN, Shemanski L, Jagust WJ, Manolio TA, Kuller L. The role of APOE epsilon4 in modulating effects of other risk factors for cognitive decline in elderly persons. JAMA 1999;282:40-46. [Free Full Text]
Murkin JM, Stump DA, Blumenthal JA, McKhann G. Defining dysfunction: group means versus incidence analysis -- a statement of consensus. Ann Thorac Surg 1997;64:904-905.
Murkin JM, Newman SP, Stump DA, Blumenthal JA. Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg 1995;59:1289-1295. [Free Full Text]
Stern Y, Gurland B, Tatemichi TK, Tang MX, Wilder D, Mayeaux R. Influence of education and occupation on the incidence of Alzheimer's disease. JAMA 1994;271:1004-1010. [Abstract]
O'Hara R, Yesavage JA, Kraemer HC, Mauricio M, Friedman LF, Murphy GM Jr. The APOE epsilon4 allele is associated with decline on delayed recall performance in community-dwelling older adults. J Am Geriatr Soc 1998;46:1493-1498. [ISI][Medline]
Slooter AJ, van Duijn CM, Bots ML, et al. Apolipoprotein E genotype, atherosclerosis, and cognitive decline: the Rotterdam Study. J Neural Transm Suppl 1998;53:17-29. [Medline]
Carmelli D, Swan GE, Reed T, et al. Midlife cardiovascular risk factors, ApoE, and cognitive decline in elderly male twins. Neurology 1998;50:1580-1585. [Abstract]
Emery CF, Schein RL, Hauck ER, MacIntyre NR. Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease. Health Psychol 1998;17:232-240. [CrossRef][ISI][Medline]
Lloyd AJ, Boyle J, Bell PR, Thompson MM. Comparison of cognitive function and quality of life after endovascular or conventional aortic aneurysm repair. Br J Surg 2000;87:443-447. [CrossRef][ISI][Medline]
Troster AI, Fields JA, Pahwa R, et al. Neuropsychological and quality of life outcome after thalamic stimulation for essential tremor. Neurology 1999;53:1774-1780. [Free Full Text]
Cohen RA, Moser DJ, Clark MM, et al. Neurocognitive functioning and improvement in quality of life following participation in cardiac rehabilitation. Am J Cardiol 1999;83:1374-1378. [CrossRef][Medline]
Newman MF, Grocott HP, Stanley TO, et al. Neurocognitive dysfunction and quality-of-life after cardiac surgery. Anesth Analg 2000;90:Suppl:SCA4-SCA4.abstract
Appendix
The members of the Neurologic Outcome Research Group and theCardiothoracic Anesthesiology Research Endeavors Investigatorsof the Duke Heart Center were as follows: Director: M. Newman;Codirector: J. Blumenthal; Anesthesiology: F. Clements, N. deBruijn, K. Grichnik, H. Grocott, S. Hill, A. Hilton, J. Mathew,J. Reves, D. Schwinn, M. Stafford Smith, A. Grigore, M. Gamoso,G. Mackensen, R. Panten, T. Stanley, L. Ti, J. Kirchner, A.Butler, V. Gaver, W. Cohen, B. Funk, M. Tirronen, W. White,and B. Phillips-Bute; Behavioral Medicine: J. Blumenthal, M.Babyak, and P. Khatri; Neurology: C. Graffagnino, D. Laskowitz,A. Saunders, and W. Strittmatter; Surgery: R. Anderson, T. D'Amico,R. Davis, D. Glower, R. Harpole, J. Jaggers, R. Jones, K. Landolfo,C. Milano, P. Smith, and W. Wolfe; Cardiology: D. Mark, E. Peterson,M. Sketch, and R. Califf.
Heyer, E. J., Gold, M. I., Kirby, E. W., Zurica, J., Mitchell, E., Halazun, H. J., Teverbaugh, L., Sciacca, R. R., Solomon, R. A., Quest, D. O., Maldonado, T. S., Riles, T. S., Connolly, E. S. Jr
(2008). A Study of Cognitive Dysfunction in Patients Having Carotid Endarterectomy Performed with Regional Anesthesia. Anesth. Analg.
107: 636-642
[Abstract][Full Text]
Singh-Manoux, A., Sabia, S., Lajnef, M., Ferrie, J. E., Nabi, H., Britton, A. R., Marmot, M. G., Shipley, M. J.
(2008). History of coronary heart disease and cognitive performance in midlife: the Whitehall II study. Eur Heart J
0: ehn298v1-8
[Abstract][Full Text]
Stroobant, N., Vingerhoets, G.
(2008). Depression, Anxiety, and Neuropsychological Performance in Coronary Artery Bypass Graft Patients: A Follow-Up Study. Psychosomatics
49: 326-331
[Abstract][Full Text]
White, A. J., Kedia, G., Mirocha, J. M., Lee, M. S., Forrester, J. S., Morales, W. C., Dohad, S., Kar, S., Czer, L. S., Fontana, G. P., Trento, A., Shah, P. K., Makkar, R. R.
(2008). Comparison of Coronary Artery Bypass Surgery and Percutaneous Drug-Eluting Stent Implantation for Treatment of Left Main Coronary Artery Stenosis. J Am Coll Cardiol Intv
1: 236-245
[Abstract][Full Text]
Djaiani, G., Ali, M., Borger, M. A., Woo, A., Carroll, J., Feindel, C., Fedorko, L., Karski, J., Rakowski, H.
(2008). Epiaortic Scanning Modifies Planned Intraoperative Surgical Management But Not Cerebral Embolic Load During Coronary Artery Bypass Surgery. Anesth. Analg.
106: 1611-1618
[Abstract][Full Text]
Rubens, F. D., Wells, G. A., Nathan, H. J.
(2008). Letter by Rubens et al Regarding Article, "Continuous-Flow Cell Saver Reduces Cognitive Decline in Elderly Patients After Coronary Bypass Surgery". Circulation
117: e348-e348
[Full Text]
Sweet, J. J., Finnin, E., Wolfe, P. L., Beaumont, J. L., Hahn, E., Marymont, J., Sanborn, T., Rosengart, T. K.
(2008). Absence of cognitive decline one year after coronary bypass surgery: comparison to nonsurgical and healthy controls.. Ann. Thorac. Surg.
85: 1571-1578
[Abstract][Full Text]
Kurlansky, P.
(2008). Invited commentary.. Ann. Thorac. Surg.
85: 1578-1578
[Full Text]
Barber, P. A., Hach, S., Tippett, L. J., Ross, L., Merry, A. F., Milsom, P.
(2008). Cerebral Ischemic Lesions on Diffusion-Weighted Imaging Are Associated With Neurocognitive Decline After Cardiac Surgery. Stroke
39: 1427-1433
[Abstract][Full Text]
Mnjoyan, Z. H., Doan, D., Brandon, J. L., Felix, K., Sitter, C. L., Rege, A. A., Brock, T. A., Fujise, K.
(2008). The critical role of the intrinsic VSMC proliferation and death programs in injury-induced neointimal hyperplasia. Am. J. Physiol. Heart Circ. Physiol.
294: H2276-H2284
[Abstract][Full Text]
Hong, S. W., Shim, J. K., Choi, Y. S., Kim, D. H., Chang, B. C., Kwak, Y. L.
(2008). Prediction of cognitive dysfunction and patients' outcome following valvular heart surgery and the role of cerebral oximetry. Eur. J. Cardiothorac. Surg.
33: 560-565
[Abstract][Full Text]
Knipp, S. C., Matatko, N., Wilhelm, H., Schlamann, M., Thielmann, M., Losch, C., Diener, H. C., Jakob, H.
(2008). Cognitive Outcomes Three Years After Coronary Artery Bypass Surgery: Relation to Diffusion-Weighted Magnetic Resonance Imaging. Ann. Thorac. Surg.
85: 872-879
[Abstract][Full Text]
Grocott, H. P.
(2008). Hyperglycemia and postoperative cognitive dysfunction: another call for better glycemic control?/L'hyperglycemie et la dysfonction cognitive postoperatoire : faut-il un meilleur controle de la glycemie?. Canadian J. Anesthesia
55: 140-145
[Full Text]
Fischer, G. W.
(2008). Recent Advances in Application of Cerebral Oximetry in Adult Cardiovascular Surgery. SEMIN CARDIOTHORAC VASC ANESTH
12: 60-69
[Abstract]
de Lange, F., Jones, W. L., Mackensen, G. B., Grocott, H. P.
(2008). The Effect of Limited Rewarming and Postoperative Hypothermia on Cognitive Function in a Rat Cardiopulmonary Bypass Model. Anesth. Analg.
106: 739-745
[Abstract][Full Text]
van Dijk, D., Moons, K. G.M., Nathoe, H. M., van Aarnhem, E. H.L., Borst, C., Keizer, A. M.A., Kalkman, C. J., Hijman, R., Octopus Study Group,
(2008). Cognitive Outcomes Five Years After Not Undergoing Coronary Artery Bypass Graft Surgery. Ann. Thorac. Surg.
85: 60-64
[Abstract][Full Text]
Savino, J. S., Cheung, A. T.
(2008). Cardiac Anesthesia. Card Surg Adult
3: 281-314
[Full Text]
Hammon, J. W.
(2008). Extracorporeal Circulation: Organ Damage. Card Surg Adult
3: 389-414
[Full Text]
Khalpey, Z. I., Ganim, R. B., Rawn, J. D.
(2008). Postoperative Care of Cardiac Surgery Patients. Card Surg Adult
3: 465-486
[Full Text]
Selnes, O. A., Grega, M. A., Bailey, M. M., Pham, L., Zeger, S., Baumgartner, W. A., McKhann, G. M.
(2007). Neurocognitive Outcomes 3 Years After Coronary Artery Bypass Graft Surgery: A Controlled Study. Ann. Thorac. Surg.
84: 1885-1896
[Abstract][Full Text]
Boodhwani, M., Rubens, F., Wozny, D., Rodriguez, R., Nathan, H. J.
(2007). Effects of sustained mild hypothermia on neurocognitive function after coronary artery bypass surgery: A randomized, double-blind study.. J. Thorac. Cardiovasc. Surg.
134: 1443-1452.e1
[Abstract][Full Text]
Puskas, J. D., Edwards, F. H., Pappas, P. A., O'Brien, S., Peterson, E. D., Kilgo, P., Ferguson, T. B. Jr
(2007). Off-Pump Techniques Benefit Men and Women and Narrow the Disparity in Mortality After Coronary Bypass Grafting. Ann. Thorac. Surg.
84: 1447-1456
[Abstract][Full Text]
Puskas, F., Grocott, H. P., White, W. D., Mathew, J. P., Newman, M. F., Bar-Yosef, S.
(2007). Intraoperative Hyperglycemia and Cognitive Decline After CABG. Ann. Thorac. Surg.
84: 1467-1473
[Abstract][Full Text]
Baumgartner, W. A.
(2007). Neurocognitive Changes After Coronary Bypass Surgery. Circulation
116: 1879-1881
[Full Text]
Djaiani, G., Fedorko, L., Borger, M. A., Green, R., Carroll, J., Marcon, M., Karski, J.
(2007). Continuous-Flow Cell Saver Reduces Cognitive Decline in Elderly Patients After Coronary Bypass Surgery. Circulation
116: 1888-1895
[Abstract][Full Text]
Ramlawi, B., Otu, H., Rudolph, J. L., Mieno, S., Kohane, I. S., Can, H., Libermann, T. A., Marcantonio, E. R., Bianchi, C., Sellke, F. W.
(2007). Genomic expression pathways associated with brain injury after cardiopulmonary bypass.. J. Thorac. Cardiovasc. Surg.
134: 996-1005.e4
[Abstract][Full Text]
Rubens, F. D., Boodhwani, M., Mesana, T., Wozny, D., Wells, G., Nathan, H. J., on behalf of the Cardiotomy Investigators,
(2007). The Cardiotomy Trial: A Randomized, Double-Blind Study to Assess the Effect of Processing of Shed Blood During Cardiopulmonary Bypass on Transfusion and Neurocognitive Function. Circulation
116: I-89-I-97
[Abstract][Full Text]
Puskas, J. D., Kilgo, P. D., Kutner, M., Pusca, S. V., Lattouf, O., Guyton, R. A.
(2007). Off-Pump Techniques Disproportionately Benefit Women and Narrow the Gender Disparity in Outcomes After Coronary Artery Bypass Surgery. Circulation
116: I-192-I-199
[Abstract][Full Text]
Kunihara, T., Tscholl, D., Langer, F., Heinz, G., Sata, F., Schafers, H.-J.
(2007). Cognitive brain function after hypothermic circulatory arrest assessed by cognitive P300 evoked potentials. Eur. J. Cardiothorac. Surg.
32: 507-513
[Abstract][Full Text]
Appelblad, M., Engstrom, K. G.
(2007). Fat content in pericardial suction blood and the efficacy of spontaneous density separation and surface adsorption in a prototype system for fat reduction. J. Thorac. Cardiovasc. Surg.
134: 366-372
[Abstract][Full Text]
de Lange, F., Dieleman, J. M., Jungwirth, B., Kalkman, C. J.
(2007). Effects of cardiopulmonary bypass on neurocognitive performance and cytokine release in old and diabetic rats. Br J Anaesth
99: 177-183
[Abstract][Full Text]
Loponen, P., Luther, M., Wistbacka, J.-O., Korpilahti, K., Laurikka, J., Sintonen, H., Huhtala, H., Tarkka, M. R.
(2007). Quality of life during 18 months after coronary artery bypass grafting. Eur. J. Cardiothorac. Surg.
32: 77-82
[Abstract][Full Text]
Kofke, W. A., Blissitt, P. A., Rao, H., Wang, J., Addya, K., Detre, J.
(2007). Remifentanil-Induced Cerebral Blood Flow Effects in Normal Humans: Dose and ApoE Genotype. Anesth. Analg.
105: 167-175
[Abstract][Full Text]
Hogue, C. W. Jr, Freedland, K., Hershey, T., Fucetola, R., Nassief, A., Barzilai, B., Thomas, B., Birge, S., Dixon, D., Schechtman, K. B., Davila-Roman, V. G.
(2007). Neurocognitive Outcomes Are Not Improved by 17{beta}-Estradiol in Postmenopausal Women Undergoing Cardiac Surgery. Stroke
38: 2048-2054
[Abstract][Full Text]
Sisillo, E., Marino, M. R., Juliano, G., Beverini, C., Salvi, L., Alamanni, F.
(2007). Comparison of on pump and off pump coronary surgery: risk factors for neurological outcome. Eur. J. Cardiothorac. Surg.
31: 1076-1080
[Abstract][Full Text]
Coburn, M., Baumert, J.-H., Roertgen, D., Thiel, V., Fries, M., Hein, M., Kunitz, O., Fimm, B., Rossaint, R.
(2007). Emergence and early cognitive function in the elderly after xenon or desflurane anaesthesia: a double-blinded randomized controlled trial. Br J Anaesth
98: 756-762
[Abstract][Full Text]
Mathew, J. P., Podgoreanu, M. V., Grocott, H. P., White, W. D., Morris, R. W., Stafford-Smith, M., Mackensen, G. B., Rinder, C. S., Blumenthal, J. A., Schwinn, D. A., Newman, M. F., for the PEGASUS Investigative Team,
(2007). Genetic Variants in P-Selectin and C-Reactive Protein Influence Susceptibility to Cognitive Decline After Cardiac Surgery. J Am Coll Cardiol
49: 1934-1942
[Abstract][Full Text]
Rubens, F. D., Nathan, H.
(2007). Lessons learned on the path to a healthier brain: dispelling the myths and challenging the hypotheses.. Perfusion
22: 153-160
[Abstract]
Rubens, F. D., Boodhwani, M., Nathan, H.
(2007). Interpreting studies of cognitive function following cardiac surgery: a guide for surgical teams.. Perfusion
22: 185-192
[Abstract]
Hammon, J. W. Jr, Stump, D. A.
(2007). Five-year cognitive outcomes: Surgical effects or natural progression of vascular disease. J. Thorac. Cardiovasc. Surg.
133: 1133-1134
[Full Text]
Nathan, H. J., Rodriguez, R., Wozny, D., Dupuis, J.-Y., Rubens, F. D., Bryson, G. L., Wells, G.
(2007). Neuroprotective effect of mild hypothermia in patients undergoing coronary artery surgery with cardiopulmonary bypass: Five-year follow-up of a randomized trial. J. Thorac. Cardiovasc. Surg.
133: 1206-1211
[Abstract][Full Text]
Silbert, B. S., Scott, D. A., Evered, L. A., Lewis, M. S., Maruff, P. T.
(2007). Preexisting Cognitive Impairment in Patients Scheduled for Elective Coronary Artery Bypass Graft Surgery. Anesth. Analg.
104: 1023-1028
[Abstract][Full Text]
Cook, D. J., Huston, J. III, Trenerry, M. R., Brown, R. D. Jr, Zehr, K. J., Sundt, T. M. III
(2007). Postcardiac Surgical Cognitive Impairment in the Aged Using Diffusion-Weighted Magnetic Resonance Imaging. Ann. Thorac. Surg.
83: 1389-1395
[Abstract][Full Text]
Kumar, R. A., Cann, C., Hall, J. E., Sudheer, P. S., Wilkes, A. R.
(2007). Predictive value of IL-18 and SC5b-9 for neurocognitive dysfunction after cardiopulmonary bypass. Br J Anaesth
98: 317-322
[Abstract][Full Text]
van Dijk, D., Spoor, M., Hijman, R., Nathoe, H. M., Borst, C., Jansen, E. W. L., Grobbee, D. E., de Jaegere, P. P. T., Kalkman, C. J., for the Octopus Study Group,
(2007). Cognitive and Cardiac Outcomes 5 Years After Off-Pump vs On-Pump Coronary Artery Bypass Graft Surgery. JAMA
297: 701-708
[Abstract][Full Text]
Berry, C., Tardif, J.-C., Bourassa, M. G.
(2007). Coronary Heart Disease in Patients With Diabetes: Part II: Recent Advances in Coronary Revascularization. J Am Coll Cardiol
49: 643-656
[Abstract][Full Text]
Motallebzadeh, R., Bland, J. M., Markus, H. S., Kaski, J. C., Jahangiri, M.
(2007). Neurocognitive Function and Cerebral Emboli: Randomized Study of On-Pump Versus Off-Pump Coronary Artery Bypass Surgery. Ann. Thorac. Surg.
83: 475-482
[Abstract][Full Text]
Wolf, L. G., Abu-Omar, Y., Choudhary, B. P., Pigott, D., Taggart, D. P.
(2007). Gaseous and solid cerebral microembolization during proximal aortic anastomoses in off-pump coronary surgery: The effect of an aortic side-biting clamp and two clampless devices. J. Thorac. Cardiovasc. Surg.
133: 485-493
[Abstract][Full Text]
Szumita, P. M., Baroletti, S. A., Anger, K. E., Wechsler, M. E.
(2007). Sedation and analgesia in the intensive care unit: Evaluating the role of dexmedetomidine. Am J Health Syst Pharm
64: 37-44
[Abstract][Full Text]
Mazer, C. D., Briet, F., Blight, K. R., Stewart, D. J., Robb, M., Wang, Z., Harrington, A. M., Mak, W., Li, X., Hare, G. M.T.
(2007). Increased cerebral and renal endothelial nitric oxide synthase gene expression after cardiopulmonary bypass in the rat. J. Thorac. Cardiovasc. Surg.
133: 13-20
[Abstract][Full Text]
Mazzoni, M., De Maria, R., Bortone, F., Parolini, M., Ceriani, R., Solinas, C., Arena, V., Parodi, O.
(2006). Long-Term Outcome of Survivors of Prolonged Intensive Care Treatment After Cardiac Surgery. Ann. Thorac. Surg.
82: 2080-2087
[Abstract][Full Text]
Xie, Z., Dong, Y., Maeda, U., Moir, R., Inouye, S. K., Culley, D. J., Crosby, G., Tanzi, R. E.
(2006). Isoflurane-Induced Apoptosis: A Potential Pathogenic Link Between Delirium and Dementia. J. Gerontol. A Biol. Sci. Med. Sci.
61: 1300-1306
[Abstract][Full Text]
Dian-San, S., Xiang-Rui, W., Yongjun, Z., Yan-Hua, Z.
(2006). Low hematocrit worsens cerebral injury after prolonged hypothermic circulatory arrest in rats: [Un niveau reduit d'hematocrite aggrave les lesions cerebrales apres un arret circulatoire hypothermique prolonge chez le rat]. Canadian J. Anesthesia
53: 1220-1229
[Abstract][Full Text]
Abu-Omar, Y., Cader, S., Wolf, L. G., Pigott, D., Matthews, P. M., Taggart, D. P.
(2006). Short-term changes in cerebral activity in on-pump and off-pump cardiac surgery defined by functional magnetic resonance imaging and their relationship to microembolization.. J. Thorac. Cardiovasc. Surg.
132: 1119-1125
[Abstract][Full Text]
Szalma, I., Kiss, A., Kardos, L., Horvath, G., Nyitrai, E., Tordai, Z., Csiba, L.
(2006). Piracetam prevents cognitive decline in coronary artery bypass: a randomized trial versus placebo.. Ann. Thorac. Surg.
82: 1430-1435
[Abstract][Full Text]
Pedley, D K, Morrison, W G
(2006). Role of thrombolytic agents in cardiac arrest.. Emerg. Med. J.
23: 747-752
[Abstract][Full Text]
Dupuis, G., Kennedy, E., Lindquist, R., Barton, F. B., Terrin, M. L., Hoogwerf, B. J., Czajkowski, S. M., Herd, J. A., for the Post CABG Biobehavioral Study Investigator,
(2006). Coronary artery bypass graft surgery and cognitive performance.. Am J Crit Care
15: 471-478
[Abstract][Full Text]
Hopkins, R. O., Jackson, J. C.
(2006). Long-term Neurocognitive Function After Critical Illness.. Chest
130: 869-878
[Abstract][Full Text]
Rosengart, T. K., Sweet, J. J., Finnin, E., Wolfe, P., Cashy, J., Hahn, E., Marymont, J., Sanborn, T.
(2006). Stable Cognition After Coronary Artery Bypass Grafting: Comparisons With Percutaneous Intervention and Normal Controls. Ann. Thorac. Surg.
82: 597-607
[Abstract][Full Text]
Motallebzadeh, R., Bland, J. M., Markus, H. S., Kaski, J. C., Jahangiri, M.
(2006). Health-Related Quality of Life Outcome After On-Pump Versus Off-Pump Coronary Artery Bypass Graft Surgery: A Prospective Randomized Study. Ann. Thorac. Surg.
82: 615-619
[Abstract][Full Text]
Vedin, J., Nyman, H., Ericsson, A., Hylander, S., Vaage, J.
(2006). Cognitive function after on or off pump coronary artery bypass grafting.. Eur. J. Cardiothorac. Surg.
30: 305-310
[Abstract][Full Text]
Shann, K. G., Likosky, D. S., Murkin, J. M., Baker, R. A., Baribeau, Y. R., DeFoe, G. R., Dickinson, T. A., Gardner, T. J., Grocott, H. P., O'Connor, G. T., Rosinski, D. J., Sellke, F. W., Willcox, T. W.
(2006). An evidence-based review of the practice of cardiopulmonary bypass in adults: A focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response.. J. Thorac. Cardiovasc. Surg.
132: 283-290.e3
[Full Text]
Djaiani, G., Fedorko, L., Cusimano, R. J., Mikulis, D., Carroll, J., Poonawala, H., Beattie, S., Karski, J.
(2006). Off-pump coronary bypass surgery: risk of ischemic brain lesions in patients with atheromatous thoracic aorta: [Le pontage aortocoronarien a coeur battant : risque de lesions cerebrales ischemiques en presence d'une aorte thoracique atheromateuse].. Canadian J. Anesthesia
53: 795-801
[Abstract][Full Text]
Kronzon, I., Tunick, P. A.
(2006). Aortic Atherosclerotic Disease and Stroke. Circulation
114: 63-75
[Full Text]
Boodhwani, M., Rubens, F. D., Wozny, D., Rodriguez, R., Alsefaou, A., Hendry, P. J., Nathan, H. J.
(2006). Predictors of Early Neurocognitive Deficits in Low-Risk Patients Undergoing On-Pump Coronary Artery Bypass Surgery. Circulation
114: I-461-I-466
[Abstract][Full Text]
Steiner, L. A., Andrews, P. J. D.
(2006). Monitoring the injured brain: ICP and CBF. Br J Anaesth
97: 26-38
[Abstract][Full Text]
Hogue, C. W. Jr, Palin, C. A., Arrowsmith, J. E.
(2006). Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices.. Anesth. Analg.
103: 21-37
[Abstract][Full Text]
Samuels, M. A.
(2006). Can Cognition Survive Heart Surgery?. Circulation
113: 2784-2786
[Full Text]
Jensen, B. O., Hughes, P., Rasmussen, L. S., Pedersen, P. U., Steinbruchel, D. A.
(2006). Cognitive Outcomes in Elderly High-Risk Patients After Off-Pump Versus Conventional Coronary Artery Bypass Grafting: A Randomized Trial. Circulation
113: 2790-2795
[Abstract][Full Text]
Bednar, M. M., Lee, T. A., Wolozin, B., Weiss, K. B., Knopman, D. S., Rocca, W. A.
(2006). Coronary artery bypass grafting is not a risk factor for dementia or Alzheimer disease. Neurology
66: 1785-1785
[Full Text]
Al-Ruzzeh, S., George, S., Bustami, M., Wray, J., Ilsley, C., Athanasiou, T., Amrani, M.
(2006). Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. BMJ
332: 1365-
[Abstract][Full Text]
Djaiani, G. N.
(2006). Aortic arch atheroma: stroke reduction in cardiac surgical patients.. SEMIN CARDIOTHORAC VASC ANESTH
10: 143-157
[Abstract]
van Dijk, D., Diephuis, J. C., Nierich, A. P., Keizer, A. M. A., Kalkman, C. J.
(2006). Beating heart versus conventional cardiopulmonary bypass: the octopus experience: a randomized comparison of 281 patients undergoing coronary artery bypass surgery with or without cardiopulmonary bypass.. SEMIN CARDIOTHORAC VASC ANESTH
10: 167-170
[Abstract]
Lewis, M. S., Maruff, P., Silbert, B. S., Evered, L. A., Scott, D. A.
(2006). Detection of Postoperative Cognitive Decline After Coronary Artery Bypass Graft Surgery is Affected by the Number of Neuropsychological Tests in the Assessment Battery. Ann. Thorac. Surg.
81: 2097-2104
[Abstract][Full Text]
Floyd, T. F., Shah, P. N., Price, C. C., Harris, F., Ratcliffe, S. J., Acker, M. A., Bavaria, J. E., Rahmouni, H., Kuersten, B., Wiegers, S., McGarvey, M. L., Woo, J. Y., Pochettino, A. A., Melhem, E. R.
(2006). Clinically Silent Cerebral Ischemic Events After Cardiac Surgery: Their Incidence, Regional Vascular Occurrence, and Procedural Dependence. Ann. Thorac. Surg.
81: 2160-2166
[Abstract][Full Text]
Hogue, C. W. Jr, Hershey, T., Dixon, D., Fucetola, R., Nassief, A., Freedland, K. E., Thomas, B., Schechtman, K.
(2006). Preexisting cognitive impairment in women before cardiac surgery and its relationship with C-reactive protein concentrations.. Anesth. Analg.
102: 1602-1608
[Abstract][Full Text]
Bokesch, P. M., Izykenova, G. A., Justice, J. B., Easley, K. A., Dambinova, S. A.
(2006). NMDA Receptor Antibodies Predict Adverse Neurological Outcome After Cardiac Surgery in High-Risk Patients. Stroke
37: 1432-1436
[Abstract][Full Text]
Sendelbach, S., Lindquist, R., Watanuki, S., Savik, K.
(2006). Correlates of Neurocognitive Function of Patients After Off-Pump Coronary Artery Bypass Surgery. Am J Crit Care
15: 290-298
[Abstract][Full Text]
Mathew, J. P., Rinder, H. M., Smith, B. R., Newman, M. F., Rinder, C. S.
(2006). Transcerebral Platelet Activation After Aortic Cross-Clamp Release is Linked to Neurocognitive Decline.. Ann. Thorac. Surg.
81: 1644-1649
[Abstract][Full Text]
Phillips-Bute, B., Mathew, J. P., Blumenthal, J. A., Grocott, H. P., Laskowitz, D. T., Jones, R. H., Mark, D. B., Newman, M. F.
(2006). Association of Neurocognitive Function and Quality of Life 1 Year After Coronary Artery Bypass Graft (CABG) Surgery. Psychosom. Med.
68: 369-375
[Abstract][Full Text]
Bhudia, S. K., Cosgrove, D. M., Naugle, R. I., Rajeswaran, J., Lam, B.-K., Walton, E., Petrich, J., Palumbo, R. C., Gillinov, A. M., Apperson-Hansen, C., Blackstone, E. H.
(2006). Magnesium as a neuroprotectant in cardiac surgery: A randomized clinical trial. J. Thorac. Cardiovasc. Surg.
131: 853-861
[Abstract][Full Text]
Zhang, T.-J., Hang, J., Wen, D.-X., Hang, Y.-N., Sieber, F. E.
(2006). Hippocampus bcl-2 and bax expression and neuronal apoptosis after moderate hypothermic cardiopulmonary bypass in rats.. Anesth. Analg.
102: 1018-1025
[Abstract][Full Text]
Fong, H. K., Sands, L. P., Leung, J. M.
(2006). The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review.. Anesth. Analg.
102: 1255-1266
[Abstract][Full Text]
(2006). Impaired baseline regional cerebral perfusion in patients referred for coronary artery bypass.. J. Thorac. Cardiovasc. Surg.
131: 540-546
Weis, F., Kilger, E., Roozendaal, B., de Quervain, D. J.-F., Lamm, P., Schmidt, M., Schmolz, M., Briegel, J., Schelling, G.
(2006). Stress doses of hydrocortisone reduce chronic stress symptoms and improve health-related quality of life in high-risk patients after cardiac surgery: A randomized study. J. Thorac. Cardiovasc. Surg.
131: 277-282
[Abstract][Full Text]
Zimpfer, D., Czerny, M., Schuch, P., Fakin, R., Madl, C., Wolner, E., Grimm, M.
(2006). Long-Term Neurocognitive Function After Mechanical Aortic Valve Replacement. Ann. Thorac. Surg.
81: 29-33
[Abstract][Full Text]
Babikian, V. L., Wolf, P. A.
(2005). Retinal and Cerebral Microembolism During On-Pump and Off-Pump Coronary Artery Bypass Graft Surgery. Circulation
112: 3816-3817
[Full Text]
Perthel, M, Kseibi, S, Sagebiel, F, Alken, A, Laas, J
(2005). Comparison of conventional extracorporeal circulation and minimal extracorporeal circulation with respect to microbubbles and microembolic signals. Perfusion
20: 329-333
[Abstract]
Lund, C., Sundet, K., Tennoe, B., Hol, P. K., Rein, K. A., Fosse, E., Russell, D.
(2005). Cerebral Ischemic Injury and Cognitive Impairment After Off-Pump and On-Pump Coronary Artery Bypass Grafting Surgery. Ann. Thorac. Surg.
80: 2126-2131
[Abstract][Full Text]
Alex, J., Laden, G., Cale, A. R.J., Bennett, S., Flowers, K., Madden, L., Gardiner, E., McCollum, P. T., Griffin, S. C.
(2005). Pretreatment with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response after cardiopulmonary bypass: A prospective randomized double-blind trial. J. Thorac. Cardiovasc. Surg.
130: 1623-1630
[Abstract][Full Text]
Mathisen, L., Andersen, M. H., Hol, P. K., Tennoe, B., Lund, C., Russell, D., Lundblad, R., Halvorsen, S., Wahl, A. K., Hanestad, B. R., Fosse, E.
(2005). Preoperative cerebral ischemic lesions predict physical health status after on-pump coronary artery bypass surgery. J. Thorac. Cardiovasc. Surg.
130: 1691-1697
[Abstract][Full Text]
A correction has been published: N Engl J Med 2001;344(24):1876.
