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Published on: August 12, 2019
Presurgical cognitive deficits in patients receiving coronary artery bypass graft surgery
Katherine P Rankin1, Gary S Kochamba, Kyle B Boone
1University of California at San Francisco Memory and Aging Center, San Francisco, California 94143-1207, USA. krankin@memory.ucsf.edu
Insights
Off-pump coronary artery bypass graft (CABG) surgery did not reduce cognitive deficits compared to traditional CABG. Patients in both groups showed significant presurgical cognitive impairments, particularly in verbal memory and psychomotor speed.
Area of Science:
- Cardiology
- Neurology
- Surgical Innovation
Background:
- Coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass (CPB) is associated with neuropsychological complications, likely due to embolization or hypoxia.
- Off-pump CABG (OPCABG) offers an alternative by avoiding heart stoppage during surgery.
Purpose of the Study:
- To investigate whether OPCABG leads to fewer cognitive deficits compared to CPB CABG.
- To assess changes in neuropsychological performance after both surgical procedures.
Main Methods:
- A neuropsychological battery was administered preoperatively to 43 patients randomized to CPB CABG or OPCABG.
- 34 patients were re-evaluated 2-3 months postoperatively by a blinded examiner.
Main Results:
- Neither OPCABG nor CPB CABG groups showed changes in neuropsychological status 2.5 months postsurgery.
- Both groups exhibited significant presurgical cognitive deficits, especially in verbal memory and psychomotor speed.
Conclusions:
- OPCABG did not demonstrate an advantage over CPB CABG in preventing postsurgical cognitive deficits.
- Significant presurgical cognitive deficits in CABG patients likely stem from underlying vascular disease.
Abstract:
Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) can produce a higher incidence of neuropsychological complications than other types of highly invasive noncardiac vascular surgery. Cognitive complications most likely arise from either embolization or hypoxia. An alternative surgical procedure has been developed that allows CABG to be performed without stopping the heart ("off-pump" CABG, or OPCABG). This study examined the neuropsychological performance of patients undergoing OPCABG, hypothesizing that patients undergoing OPCABG would show fewer cognitive deficits than patients whose hearts were stopped. A 1-hr neuropsychological battery was administered preoperatively to 43 patients before prospective randomization to either CPB CABG or OPCABG, and again to 34 of those patients 2 to 3 months postoperatively by an examiner blind to surgical condition. Neuropsychological status did not change 2.5 months postsurgically in either OPCABG or CABG groups. However, both groups showed dramatic presurgical cognitive deficits in multiple domains, particularly verbal memory and psychomotor speed. This corroborates previous research suggesting that patients requiring CABG surgery may evidence significant presurgical cognitive deficits as a result of existing vascular disease.
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