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Ann Thorac Surg 1995;59:1289-1295
© 1995 The Society of Thoracic Surgeons

Symposium: Conference on Cardiopulmonary Bypass

Statement of Consensus on Assessment of Neurobehavioral Outcomes After Cardiac Surgery

John M. Murkin, MD, Stanton P. Newman, DPhil, David A. Stump, PhD, James A. Blumenthal, PhD

Department of Anaesthesia, University Hospital, University of Western Ontario, London, Ontario, Canada; Department of Psychiatry, University College London Medical School, London, United Kingdom; Department of Anesthesia, The Bowman Gray School of Medicine of Wake Forest University, Winston Salem, North Carolina; and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina

Dr Murkin, Department of Anaesthesia, University Hospital, 339 Windermere Rd, London, Ont, Canada N6A 5A5.

The first 300 words of the full text of this article appear below.

At the recent meeting CNS Dysfunction After Cardiac Surgery: Defining the Problem, held December 10 and 11 in Fort Lauderdale, FL, a draft statement outlining proposed criteria for the assessment of central nervous system (CNS) outcomes after cardiac surgery was circulated beforehand to all registrants and invited speakers. The intent of the draft statement was to act as a focus for discussion by the audience of assembled experts from diverse disciplines including psychology, neuropsychology, neurology, neuroradiology, brain ischemia research, anesthesia, cardiovascular surgery, and epidemiology and biostatistics. After a 12-hour lecture program in which issues relevant to neurobehavioral outcome research were presented by a multidisciplinary group of international experts, the last 4 hours of the conference was devoted to an open discussion and critique of the draft Statement of Consensus. These proceedings were audiotaped and transcribed, and a version of the discussion, edited for syntax, follows.

For clarity, the approved Consensus Statement is presented first, followed by a transcription of the point by point discussion of each of the statements appearing in the original draft. Where possible, speakers have been identified and are listed at the end.

Consensus Statement (Approved)

  1. A spectrum of postoperative central nervous system (CNS) dysfunction both acute and persistent occurs in a proportion of patients after cardiac surgical procedures, including brain death, stroke, subtle neurologic signs, and neuropsychologic impairment.
  2. A number of patients presenting for a cardiac operation have preexisting CNS abnormalities. A patient's neurologic and neuropsychologic state needs to be assessed at a time prior to operation to provide accurate baseline information.
  3. The individual change in performance from baseline to a time after operation is essential to any evaluation of the impact of the operation or any intervention associated with it.
  4. When indicated, designs should incorporate the use of a control or comparison group.
  5. Because of the time constraints . . . [Full Text of this Article]




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 Eur. J. Cardiothorac. Surg.Home page
P. D. Raymond, A. D. Hinton-Bayre, M. Radel, M. J. Ray, and N. A. Marsh
Assessment of statistical change criteria used to define significant change in neuropsychological test performance following cardiac surgery
Eur. J. Cardiothorac. Surg., January 1, 2006; 29(1): 82 - 88.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
J. W. Hammon, D. A. Stump, J. F. Butterworth, D. M. Moody, K. Rorie, D. D. Deal, E. H. Kincaid, T. E. Oaks, and N. D. Kon
Single crossclamp improves 6-month cognitive outcome in high-risk coronary bypass patients: The effect of reduced aortic manipulation
J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 114 - 121.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
J. Alex, G. Laden, A. R.J. Cale, S. Bennett, K. Flowers, L. Madden, E. Gardiner, P. T. McCollum, and S. C. Griffin
Pretreatment with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response after cardiopulmonary bypass: A prospective randomized double-blind trial
J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1623 - 1630.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
J. Butterworth, L. E. Wagenknecht, C. Legault, D. J. Zaccaro, N. D. Kon, J. W. Hammon Jr, A. T. Rogers, B. T. Troost, D. A. Stump, C. D. Furberg, et al.
Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting
J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1319 - 1319.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
E. W. Thornton, C. Groom, B. M. Fabri, M. A. Fox, C. Hallas, and M. Jackson
Quality of life outcomes after coronary artery bypass graft surgery: Relationship to neuropsychologic deficit
J. Thorac. Cardiovasc. Surg., October 1, 2005; 130(4): 1022 - 1027.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. S. Lewis, P. T. Maruff, and B. S. Silbert
Examination of the Use of Cognitive Domains in Postoperative Cognitive Dysfunction After Coronary Artery Bypass Graft Surgery
Ann. Thorac. Surg., September 1, 2005; 80(3): 910 - 916.
[Abstract] [Full Text] [PDF]

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 PerfusionHome page
A. Khosravi, C. A Skrabal, B. Westphal, G. Kundt, B. Greim, E. Kunesch, A. Liebold, and G. Steinhoff
Evaluation of coated oxygenators in cardiopulmonary bypass systems and their impact on neurocognitive function
Perfusion, September 1, 2005; 20(5): 249 - 254.
[Abstract] [PDF]

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 J. Neurol. Neurosurg. PsychiatryHome page
A C Kneebone, M A Luszcz, R A Baker, and J L Knight
A syndromal analysis of neuropsychological outcome following coronary artery bypass graft surgery
J. Neurol. Neurosurg. Psychiatry, August 1, 2005; 76(8): 1121 - 1127.
[Abstract] [Full Text] [PDF]

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 Anesth. Analg.Home page
S. Himmelseher and M. E. Durieux
Revising a Dogma: Ketamine for Patients with Neurological Injury?
Anesth. Analg., August 1, 2005; 101(2): 524 - 534.
[Abstract] [Full Text] [PDF]

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 ICVTSHome page
Y. Carrascal, E. Casquero, J. Gualis, S. Di Stefano, S. Florez, E. Fulquet, J. R. Echevarria, and L. Fiz
Cognitive decline after cardiac surgery: proposal for easy measurement with a new test
Interactive CardioVascular and Thoracic Surgery, June 1, 2005; 4(3): 216 - 221.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. Baufreton, P. Allain, A. Chevailler, F. Etcharry-Bouyx, J. J. Corbeau, D. Legall, and J. L. de Brux
Brain Injury and Neuropsychological Outcome After Coronary Artery Surgery Are Affected by Complement Activation
Ann. Thorac. Surg., May 1, 2005; 79(5): 1597 - 1605.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
Y. Kadoi, S. Saito, N. Fujita, and F. Goto
Risk factors for cognitive dysfunction after coronary artery bypass graft surgery in patients with type 2 diabetes
J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 576 - 583.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Dogan, T. Aybek, P. S. Risteski, F. Detho, A. Rapp, G. Wimmer-Greinecker, and A. Moritz
Minimally Invasive Port Access Versus Conventional Mitral Valve Surgery: Prospective Randomized Study
Ann. Thorac. Surg., February 1, 2005; 79(2): 492 - 498.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
E. Iriz, F. Kolbakir, H. Akar, B. Adam, and H. T. Keceligil
Comparison of Hydroxyethyl Starch and Ringer Lactate as a Prime Solution Regarding S-100{beta} Protein Levels and Informative Cognitive Tests in Cerebral Injury
Ann. Thorac. Surg., February 1, 2005; 79(2): 666 - 671.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
P. Wahrborg, J. E. Booth, T. Clayton, F. Nugara, J. Pepper, W. S. Weintraub, U. Sigwart, R. H. Stables, and for the SoS Neuropsychology Substudy Investigators
Neuropsychological Outcome After Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting: Results From the Stent or Surgery (SoS) Trial
Circulation, November 30, 2004; 110(22): 3411 - 3417.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
S. Bar-Yosef, M. Anders, G. B. Mackensen, L. K. Ti, J. P. Mathew, B. Phillips-Bute, R. H. Messier, H. P. Grocott, and the Neurological Outcome Research Group and CARE I
Aortic Atheroma Burden and Cognitive Dysfunction After Coronary Artery Bypass Graft Surgery
Ann. Thorac. Surg., November 1, 2004; 78(5): 1556 - 1562.
[Abstract] [Full Text] [PDF]

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 Anesth. Analg.Home page
G. Iohom, S. Szarvas, V. Larney, J. O'Brien, E. Buckley, M. Butler, and G. Shorten
Perioperative Plasma Concentrations of Stable Nitric Oxide Products Are Predictive of Cognitive Dysfunction After Laparoscopic Cholecystectomy
Anesth. Analg., October 1, 2004; 99(4): 1245 - 1252.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
D.K. Harrington, A.S. Walker, H. Kaukuntla, R.M. Bracewell, T.H. Clutton-Brock, M. Faroqui, D. Pagano, and R.S. Bonser
Selective Antegrade Cerebral Perfusion Attenuates Brain Metabolic Deficit in Aortic Arch Surgery: A Prospective Randomized Trial
Circulation, September 14, 2004; 110(11_suppl_1): II-231 - II-236.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
H. Kaukuntla, A. Walker, D. Harrington, T. Jones, and R. S. Bonser
Differential brain and body temperature during cardiopulmonary bypass--a randomised clinical study
Eur. J. Cardiothorac. Surg., September 1, 2004; 26(3): 571 - 579.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
S. Martens, M. Dietrich, C. Herzog, M. Doss, G. Schneider, A. Moritz, and G. Wimmer-Greinecker
Automatic connector devices for proximal anastomoses do not decrease embolic debris compared with conventional anastomoses in CABG
Eur. J. Cardiothorac. Surg., June 1, 2004; 25(6): 993 - 1000.
[Abstract] [Full Text] [PDF]

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 Br J AnaesthHome page
B. S. Silbert, P. Maruff, L. A. Evered, D. A. Scott, M. Kalpokas, K. J. Martin, M. S. Lewis, and P. S. Myles
Detection of cognitive decline after coronary surgery: a comparison of computerized and conventional tests
Br. J. Anaesth., June 1, 2004; 92(6): 814 - 820.
[Abstract] [Full Text] [PDF]

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 Anesth. Analg.Home page
W. Nagels, R. Demeyere, J. Van Hemelrijck, E. Vandenbussche, K. Gijbels, and E. Vandermeersch
Evaluation of the Neuroprotective Effects of S(+)-Ketamine During Open-Heart Surgery
Anesth. Analg., June 1, 2004; 98(6): 1595 - 1603.
[Abstract] [Full Text] [PDF]

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 JAMAHome page
J. D. Puskas, W. H. Williams, E. M. Mahoney, P. R. Huber, P. C. Block, P. G. Duke, J. R. Staples, K. E. Glas, J. J. Marshall, M. E. Leimbach, et al.
Off-Pump vs Conventional Coronary Artery Bypass Grafting: Early and 1-Year Graft Patency, Cost, and Quality-of-Life Outcomes: A Randomized Trial
JAMA, April 21, 2004; 291(15): 1841 - 1849.
[Abstract] [Full Text] [PDF]

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 HeartHome page
D van Dijk, K G M Moons, A M A Keizer, E W L Jansen, R Hijman, J C Diephuis, C Borst, P P T de Jaegere, D E Grobbee, and C J Kalkman
Association between early and three month cognitive outcome after off-pump and on-pump coronary bypass surgery
Heart, April 1, 2004; 90(4): 431 - 434.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
M. Jahangiri and R. Motallebzadeh
Neurocognitive deficit following mitral valve surgery
Eur. J. Cardiothorac. Surg., October 1, 2003; 24(4): 665 - 665.
[Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
R. J. Petrucci
Finding our way from the heart to the head
J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 944 - 946.
[Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
D.K. Harrington, M. Bonser, A. Moss, M.T.E. Heafield, M.J. Riddoch, and R.S. Bonser
Neuropsychometric outcome following aortic arch surgery: a prospective randomized trial of retrograde cerebral perfusion
J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 638 - 644.
[Abstract] [Full Text] [PDF]

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 Anesth. Analg.Home page
D. J. Culley, G. Crosby, J. Butterworth, and J. W. Hammon
Mechanisms of Postoperative Neurobehavioral Deficits and Stroke May Differ * Response
Anesth. Analg., August 1, 2003; 97(2): 601 - 601.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. D. Lee, S. J. Lee, W. T. Tsushima, H. Yamauchi, W. T. Lau, J. Popper, A. Stein, D. Johnson, D. Lee, H. Petrovitch, et al.
Benefits of off-pump bypass on neurologic and clinical morbidity: a prospective randomized trial
Ann. Thorac. Surg., July 1, 2003; 76(1): 18 - 26.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
Y. Kadoi, S. Saito, F. Kunimoto, F. Goto, and N. Fujita
Comparative effects of propofol versus fentanyl on cerebral oxygenation state during normothermic cardiopulmonary bypass and postoperative cognitive dysfunction
Ann. Thorac. Surg., March 1, 2003; 75(3): 840 - 846.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
E. Ahlgren, A. Lundqvist, A. Nordlund, C. Aren, and H. Rutberg
Neurocognitive impairment and driving performance after coronary artery bypass surgery
Eur. J. Cardiothorac. Surg., March 1, 2003; 23(3): 334 - 340.
[Abstract] [Full Text] [PDF]

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 BMJHome page
V. Zamvar, D. Williams, J. Hall, N. Payne, C. Cann, K. Young, S Karthikeyan, and J. Dunne
Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: prospective randomised controlled trial
BMJ, November 30, 2002; 325(7375): 1268 - 1268.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Dogan, K. Graubitz, T. Aybek, M. F. Khan, P. Kessler, A. Moritz, and G. Wimmer-Greinecker
How safe is the port access technique in minimally invasive coronary artery bypass grafting?
Ann. Thorac. Surg., November 1, 2002; 74(5): 1537 - 1543.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
D. Wang, X. Wu, J. Li, F. Xiao, X. Liu, and M. Meng
The Effect of Lidocaine on Early Postoperative Cognitive Dysfunction After Coronary Artery Bypass Surgery
Anesth. Analg., November 1, 2002; 95(5): 1134 - 1141.
[Abstract] [Full Text] [PDF]


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