Neurologic outcomes after coronary artery bypass grafting with and without cardiopulmonary bypass.

Journal Article (Review)

Neurologic injury, in the form of either stroke or more subtle neurocognitive impairment, is a frequent and potentially devastating complication of coronary artery bypass grafting (CABG). The etiology of CABG-associated neurologic injury is likely multifactorial, with the phenomena of cerebral hypoperfusion and embolism being the major contributors. Several perioperative strategies have been developed in an effort to reduce the incidence of CABG-associated neurologic complications. Hypothermic cerebral perfusion, alpha stat acid-base management, and slow patient rewarming have been shown by several investigators to minimize adverse neurologic sequelae associated with the use of cardiopulmonary bypass. Performing CABG without cardiopulmonary bypass (off-pump CABG), meanwhile, has been shown to reduce the risk of perioperative stroke, especially in high-risk patients such as the elderly. Whether off-pump CABG reduces the incidence of less severe neurocognitive impairment has not yet been clearly established and merits further investigation in the form of large, multicenter, randomized trials. Other technical innovations, such as the use of sutureless and clampless aortic anastomotic devices, also may be able to further minimize the neurologic complications associated with CABG.

Full Text

Duke Authors

Cited Authors

  • Scarborough, JE; White, W; Derilus, FE; Mathew, JP; Newman, MF; Landolfo, KP

Published Date

  • January 2003

Published In

Volume / Issue

  • 15 / 1

Start / End Page

  • 52 - 62

PubMed ID

  • 12813690

International Standard Serial Number (ISSN)

  • 1043-0679

Language

  • eng

Conference Location

  • United States