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Volume 335:1857-1864 December 19, 1996 Number 25 Next

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ABSTRACT

Background Acute changes in cerebral function after elective coronary bypass surgery are a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of — and the use of resources associated with — perioperative adverse neurologic events, including cerebral injury.

Methods In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures).

Results Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of 3.1 percent had type I neurologic outcomes (8 died of cerebral injury, 55 had nonfatal strokes, 2 had transient ischemic attacks, and 1 had stupor), and 3.0 percent had type II outcomes (55 had deterioration of intellectual function and 8 had seizures). Patients with adverse cerebral outcomes had higher in-hospital mortality (21 percent of patients with type I outcomes died, vs. 10 percent of those with type II and 2 percent of those with no adverse cerebral outcome; P<0.001 for all comparisons), longer hospitalization (25 days with type I outcomes, 21 days with type II, and 10 days with no adverse outcome; P<0.001), and a higher rate of discharge to facilities for intermediate- or long-term care (47 percent, 30 percent, and 8 percent; P<0.001). Predictors of type I outcomes were proximal aortic atherosclerosis, a history of neurologic disease, and older age; predictors of type II outcomes were older age, systolic hypertension on admission, pulmonary disease, and excessive consumption of alcohol.

Conclusions Adverse cerebral outcomes after coronary bypass surgery are relatively common and serious; they are associated with substantial increases in mortality, length of hospitalization, and use of intermediate- or long-term care facilities. New diagnostic and therapeutic strategies must be developed to lessen such injury.

Source Information

From Kaiser Permanente Medical Center, San Francisco (G.W.R.); New York University, N.Y. (M.K., K.M.); Stanford University, Stanford, Calif. (C.M.M.); Duke University, Durham, N.C. (M.N.); Mercy Medical Center, Redding, Calif. (N.N.); Medical College of Virginia, Richmond (R.W.); Veterans Affairs Medical Center, Milwaukee (A.A.); University of Pittsburgh, Pittsburgh (S.H.G.); the Ischemia Research and Education Foundation, San Francisco (C.L.); and the Veterans Affairs Medical Center, San Francisco (G.O., D.T.M.). Other authors were Ahvie Herskowitz, M.D., Vera Katseva, Ph.D., and Rita Sears, R.N., M.S.

Address reprint requests to Dr. Dennis Mangano at the Ischemia Research and Education Foundation, 250 Executive Park Blvd., Suite 3400, San Francisco, CA 94134.

Full Text of this Article

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Extract | Full Text  
N Engl J Med 1997; 336:1605-1607, May 29, 1997. Correspondence

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• 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]  
• Kadoi, Y., Takahashi, K.-i., Saito, S., Goto, F. (2006). The comparative effects of sevoflurane versus isoflurane on cerebrovascular carbon dioxide reactivity in patients with diabetes mellitus.. Anesth. Analg. 103: 168-172 [Abstract] [Full Text]  
• Goldstein, L. B., Adams, R., Alberts, M. J., Appel, L. J., Brass, L. M., Bushnell, C. D., Culebras, A., DeGraba, T. J., Gorelick, P. B., Guyton, J. R., Hart, R. G., Howard, G., Kelly-Hayes, M., Nixon, J.V., Sacco, R. L. (2006). Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline.. Circulation 113: e873-e923 [Abstract] [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]  
• Djaiani, G. N. (2006). Aortic arch atheroma: stroke reduction in cardiac surgical patients.. SEMIN CARDIOTHORAC VASC ANESTH 10: 143-157 [Abstract]  
• 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]  
• Goldstein, L. B., Adams, R., Alberts, M. J., Appel, L. J., Brass, L. M., Bushnell, C. D., Culebras, A., DeGraba, T. J., Gorelick, P. B., Guyton, J. R., Hart, R. G., Howard, G., Kelly-Hayes, M., Nixon, J.V., Sacco, R. L. (2006). Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline.. Stroke 37: 1583-1633 [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]  
• Zingone, B., Rauber, E., Gatti, G., Pappalardo, A., Benussi, B., Dreas, L., Lattuada, L. (2006). The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke.. Eur. J. Cardiothorac. Surg. 29: 720-728 [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]  
• 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]  
• (2006). Impaired baseline regional cerebral perfusion in patients referred for coronary artery bypass.. J. Thorac. Cardiovasc. Surg. 131: 540-546  
• 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]  
• Quinn, D. W., Pagano, D., Bonser, R. S., Rooney, S. J., Graham, T. R., Wilson, I. C., Keogh, B. E., Townend, J. N., Lewis, M. E., Nightingale, P., Study Investigators, (2006). Improved myocardial protection during coronary artery surgery with glucose-insulin-potassium: A randomized controlled trial. J. Thorac. Cardiovasc. Surg. 131: 34-42 [Abstract] [Full Text]  
• Rudolph, J. L, Tilahun, D., Treanor, P. R, Pochay, V. E, Mahendrakar, M. A, Sagar, P., Babikian, V. L (2006). Use of a large bore syringe creates significantly fewer high intensity transient signals (HITS) into a cardiopulmonary bypass system than a small bore syringe. Perfusion 21: 67-71 [Abstract]