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Ann Thorac Surg 1999;67:1676
© 1999 The Society of Thoracic Surgeons

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Invited Commentaries

^a Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009 USA,

Invited commentary

This excellent study highlights the many difficulties of investigating a patient population with such a complicated compilation of moving data sets. Patients who undergo coronary artery bypass graft (CABG) surgery have significant vascular disease that often includes organs other than the heart. Simonetta et al. [1] have demonstrated that as many as 9 of 10 patients have abnormal magnetic resonance imaging scans of the brain, half of which have evidence of infarction before CABG surgery. Unfortunately, CABG surgery does not stop the progression of vascular disease; it merely alleviates site-specific symptoms in the heart. Patients with preoperative organ damage, secondary to diabetes, hypertension, or atherosclerosis, may indeed respond to cardiopulmonary bypass differently than patients with more focal cardiac disease. Therefore, it should not come as a surprise that, postoperatively, some patients will develop symptoms that are actually unrelated to the surgery and thereby confound the statistical model.

This paper addresses a very difficult topic, the longitudinal study of cognitive function. If a patient develops a neurobehavioral dysfunction after a surgical intervention, such as cardiac surgery, it is difficult to determine if the symptoms are secondary to the ongoing disease process, a consequence of the surgical procedure, or an interaction of the two. The experimental approach used by the Johns Hopkins group elucidates the relative contribution of intraoperative and patient-specific variables to postoperative neurobehavioral deficits. When it is possible to identify the specific events or risk factors that cause neurologic injury during cardiac surgery, then we can intelligently recommend changes to the surgeon to help make a safe operation safer.

The authors of this paper wisely conclude that larger, more focused studies are required before it is possible to make recommendations on how to improve surgical management to improve outcomes. But the very fact this question is addressed gives hope that the answers will be forthcoming in the near future.

References

1. Simonetta AB, Moody DM, Reboussin DM, Stump DA, Legault C, Kon ND. Magnetic Resonance Imaging and Cardiac Surgery. In: Newman SP, Harrison M, Stump DA, Taylor K, Smith P, ed. The Brain and Cardiac Surgery. London: Oxford University Press, 1999 in press

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): David A. Stump Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Stump, D. A. Search for Related Content PubMed Articles by Stump, D. A. Related Collections Related Article