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(Circulation. 2005;112:3816-3817.)
© 2005 American Heart Association, Inc.

Editorial

Retinal and Cerebral Microembolism During On-Pump and Off-Pump Coronary Artery Bypass Graft Surgery

Viken L. Babikian, MD; Philip A. Wolf, MD

From Department of Neurology, Boston University School of Medicine, and Boston Medical Center, Boston, Mass.

Correspondence to Philip A. Wolf, MD, Neurological Epidemiology and Genetics, Boston University School of Medicine, 715 Albany St, B-608, Boston, MA 02118-2526. E-mail pawolf@bu.edu

Key Words: Editorials • cardiopulmonary bypass • embolism • stroke • cerebral infarction

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Stroke, delirium, cognitive decline, and depressed mood in the days and weeks after surgery, as well as a late long-term decline in cognitive function, are the most common neurological complications of coronary artery bypass graft (CABG) surgery performed with cardiopulmonary bypass (CPB). Delirium has been reported in 10% to 40% of patients, usually occurring transiently in the immediate postoperative period.¹ Brain infarction occurs in 1% to 5% of patients^2,3; in 60% of these patients, it is detected in the first 24 postoperative hours, and it occurs during the subsequent 10 days in another 35%.^4,5 Cognitive decline occurs in up to 24% of cases at 6 months after CABG.⁶ Depressive symptoms and self-reported decline in cognitive function are frequently encountered in clinical practice, although they are less well documented in systematic objective testing.⁷ Although the overall complication rate has decreased over the past 25 years with improved operative techniques, given the more than 400 000 yearly CABG procedures, these adverse effects on the brain are a substantial public health concern. Prevention through a better understanding of their mechanisms remains a desirable and important goal.

Article p 3833

Clinical variables associated with these neurological complications include age, prior cerebrovascular or peripheral arterial disease, congestive heart failure, and CPB duration of more than 2 hours.^5,8,9 Patient selection, surgical skill, and operative technique also influence the development of these complications.^10,11

The mechanisms of neurological complications after CABG performed with CPB (on-pump CABG) remain incompletely understood. Brain infarction secondary to extracranial internal carotid artery . . . [Full Text of this Article]