NEUROLOGICAL OUTCOME AFTER CORONARY ARTERY BYPASS SURGERY

Authors

  • Ammar Hameed Khan
  • Shahbaz Ahmad Khilji

Abstract

Background: Neurological dysfunction is a common complication after cardiac surgery. Despite significant advances in cardiopulmonary bypass (CPB) technology, surgical techniques and anaesthetic management, central nervous system complications occur in a large number of patients undergoing surgery requiring CPB. The objective of this study was to determine neurocognitive status of the patients undergoing coronary artery bypass grafting (CABG) and to find any causative or associated factor. Methods: We evaluated 1000 consecutive patients undergoing primary isolated coronary artery bypass grafting (CABG) at a tertiary care cardiac institute from July 2000 to December 2001 to determine the neurological outcome after CABG and risk factors involved. The demographic and perioperative data were analyzed by X2 analysis. Results: A history of diabetes, hypertension, increased age, preoperative neurological event, aortic atheromatous / calcific disease, bilateral carotid artery disease, intermittent aortic cross clamping and evidence of mural thrombi are all co-related with increased risk of neurological damage after CABG. When analyzed in a stepwise logistic regression model, diabetes mellitus, aortic disease, increased age and mural thrombi carried a higher probability that the patient would have a postoperative neurological deficit. Conclusions: We conclude that although these factors are individually involved in the adverse neurological outcome after CABG but the combination of these factors greatly increases the risk of postoperative neurological consequences and only few of them are avoidable.Key words: CABG, CPB, complications, neurological, risk factors, PIC.

References

Strenge H, Lindner V, Paulsen G, Regensburger D, Tiemann S. Early neurological abnormalities following coronary artery bypass surgery, a prospective study. Eur Arch Psychiatry Neurol Sci 1999; 239(4):277-81.

Stump DA, Newman SP. Emboli detection during cardiopulmonary bypass. In: Tegler C.H., Babikian V.L., Gomez C.T., eds. Neurosonology. St. Louis:Mosby;1996:252-5.

Ferraris VA, Ferraris SP. Risk Factors for postoperative morbidity. J Thorac Cardiovasc Surg 1996; 111:731-41.

HattIer BG, Madia C, Johnson C. Risk stratification using the Society of Thoracic Surgeons program. Ann Thorac Surg 1998;58: 1348-52.

Baker RA, Andrew MJ, Knight JL. Evaluation of neurological assessment and outcomes in cardiac surgical patients. Semin Thorac Cardiovasc Surg 2001; 13(2): 149-57.

Bowles JB, Lee JD, Dang CR. Coronary artery bypass performed without use of cardiopulmonary bypass is associated with reduced cerebral microemboli and improved clinical results. Chest 2001;119:25-30.

Wahl GW, Swinburne AJ, Fedullo AJ, Lee DK, Bixby K. Long term outcome when major complications follow coronary artery bypass graft surgery. Recoveries after complicated coronary artery bypass graft surgery. Chest 1999;110(6):1394-8.

Nussmeier NA. A review of risk factors for adverse neurological outcome after cardiac surgery. J Extra Corpor Technol 2002;34(1): 4­-10.

Newman M.F, Wolman R, Kanchuger M. Multicenter preoperative stroke risk index for patients undergoing coronary artery bypass graft surgery. Circulation 1996;94(suppl 2):II-74-II-80.

Neville MJ, Butterworth J, James RL, Hammon JW, Stump DA. Similar neurobehavioral outcome after valve or coronary artery operations despite differing carotid embolic counts. J Thorac Cardiovasc Surg 2001;121(1):125-36.

Pompilio G, Lotto AA, Agrifoglio M, Antona C, Alamanni F, Spirito R. Nonembolic predictors of stroke risk in coronary artery bypass patients. World J Surg 1999; 23(7):657-63.

Tuman KJ, Mc RJ, Najafi H, Ivankovich AD. Differential effects of advanced age on the neurological and cardiac risks of coronary artery operations. J Thorac Cardiovasc Surg 1999, 104: 1510-7.