| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;78:518-519
© 2004 The Society of Thoracic Surgeons
Department of Neurology, The Johns Hopkins Hospital, 600 North Wolfe St, Meyer 100, Baltimore, MD 21287, USA
e-mail: oselnes{at}jhmi.edu
Numerous studies have made attempts in the past to quantify cognitive changes associated with the use of cardiopulmonary bypass, but it is only more recently that control groups for such studies have been introduced. In this issue, Zimpfer and associates compare neurophysiologic and cognitive changes in a group of patients undergoing coronary artery bypass grafting (CABG) surgery with those of a control group of inpatients on the internal medicine service. They conclude, largely on the basis of the P300 evoked potential changes, that the CABG patients have persistent neurocognitive impairment when retested at 7 days, 4 months, and 3 years after surgery.
Results from recent studies relying on conventional neuropsychological tests have indicated that early postoperative cognitive changes after CABG may be transient and reversible, and that the majority of patients recover by approximately 3 months after surgery. The P300 results in the present study did not show this trend, however, although the authors have previously reported results from a somewhat larger cohort suggesting that the P300 measurements were "almost normalized" by 4 months after surgery.
The findings of long-term changes in the P300 evoked potentials up to 3 years after surgery appear to be consistent with those from previous studies in which traditional neurocognitive measures were used, but absent a control group. Nonetheless, the interpretation of these long-term evoked potential changes after CABG (and those of previous other studies involving traditional cognitive outcomes measures) requires caution, because the "decline" seen at 3 years may not necessarily be directly or causally related to the use of cardiopulmonary bypass itself. It is possible that the 3-year changes reflect new events in the brain secondary to progression of underlying cerebrovascular disease. Previous magnetic resonance imaging studies have documented that new silent lesions may occur in as many as one third of patients between 3 and 12 months after bypass surgery.
Ultimately, for a more definite understanding of the implications from this study, more data will be needed to demonstrate how the slowing of the P300 evoked potentials correlates with either self-reported cognitive symptoms or objective measures of cognitive change, and also with new lesions as demonstrated by magnetic resonance imaging.
This article has been cited by other articles:
|
|
 |
|
  J. P. Mathew, G. B. Mackensen, B. Phillips-Bute, H. P. Grocott, D. D. Glower, D. T. Laskowitz, J. A. Blumenthal, M. F. Newman, and for the Neurologic Outcome Research Group (NORG) o Randomized, Double-Blinded, Placebo Controlled Study of Neuroprotection With Lidocaine in Cardiac Surgery Stroke, March 1, 2009; 40(3): 880 - 887. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Hachinski, C. Iadecola, R. C. Petersen, M. M. Breteler, D. L. Nyenhuis, S. E. Black, W. J. Powers, C. DeCarli, J. G. Merino, R. N. Kalaria, et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards Stroke, September 1, 2006; 37(9): 2220 - 2241. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
