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Published on: March 27, 2018
Neurocognitive outcomes 3 years after coronary artery bypass graft surgery: a controlled study
Ola A Selnes1, Maura A Grega, Maryanne M Bailey
1Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. oselnes@jhmi.edu
Insights
Cognitive decline after coronary artery bypass graft (CABG) surgery is not specifically linked to cardiopulmonary bypass. Late cognitive performance showed no significant differences between on-pump and off-pump procedures.
Area of Science:
- Neurology
- Cardiovascular Surgery
Background:
- Cardiopulmonary bypass (CPB) is suspected in late cognitive decline post-coronary artery bypass graft (CABG) surgery.
- Previous studies lacked control groups, preventing causal links to CPB.
Purpose of the Study:
- To investigate the causal link between CPB and late cognitive decline after CABG.
- To compare cognitive performance changes in patients undergoing on-pump CABG versus control groups.
Main Methods:
- Compared cognitive performance changes over 3 years in 152 on-pump CABG patients.
- Utilized three control groups: off-pump surgery (75), no surgery (99), and healthy controls (69).
- Assessed neuropsychological performance using standardized tests for attention, memory, executive function, and speed.
Main Results:
- No group showed significantly lower cognitive performance at 36 months compared to baseline.
- No significant differences in cognitive change were observed between on-pump and off-pump surgery groups from 12 to 36 months.
- A mild, nonsignificant trend toward cognitive decline was noted across all coronary artery disease groups.
Conclusions:
- Late postoperative cognitive decline after CABG is not specific to the use of cardiopulmonary bypass.
- Findings suggest other factors may contribute to cognitive changes observed after bypass surgery.
- No significant difference in late cognitive decline between on-pump and off-pump CABG procedures.
Background:
Cardiopulmonary bypass has been implicated in the late cognitive decline that has been reported after coronary artery bypass graft (CABG) surgery. Because most studies did not include a control group, a causal link of such decline with the use of cardiopulmonary bypass has not been established.
Methods:
We compared changes in cognitive performance from baseline to 3 years in patients undergoing on-pump CABG (n = 152) with those of three control groups: patients with off-pump surgery (n = 75); with diagnosed coronary artery disease but no surgery (n = 99); and without coronary artery disease risk factors (n = 69). Neuropsychological performance was assessed by standardized tests of attention, language, verbal and visual memory, visuospatial, executive function, and psychomotor and motor speed.
Results:
Relative to their baseline performance, no group had significantly lower performance at 36 months for any of the cognitive domains. From 12 to 36 months, there were no statistically significant differences in the degree of change between the on- and off-pump surgery groups. There was a trend toward mild decline in some cognitive domains, but overall differences among groups in degree of change over time were not statistically significant.
Conclusions:
We found a mild but nonsignificant trend toward late postoperative cognitive decline for all study groups with coronary artery disease, but no significant differences in the degree of late postoperative cognitive decline after on-pump compared with off-pump surgery. These findings suggest that previously reported late decline after bypass surgery is not specific to use of cardiopulmonary bypass.
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