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(Circulation. 2004;110:3402-3403.)
© 2004 American Heart Association, Inc.

Editorial

Fixing the Heart

Must the Brain Pay the Price?

Mark F. Newman, MD; James A. Blumenthal, PhD; Daniel B. Mark, MD, MPH

From the Neurologic Outcomes Research Group (M.F.N., J.A.B., D.B.M.) and the Outcomes Research and Assessment Group, Duke Clinical Research Institute (D.B.M.), and the Department of Psychiatry & Behavioral Sciences (J.A.B.) and the Department of Anesthesiology (M.F.N.), Duke University Medical Center, Durham, NC.

Correspondence to Mark F. Newman, MD, Duke University Medical Center, DUMC 3094, 2100 Erwin Rd, Durham, NC 27710. E-mail newma005@mc.duke.edu

Key Words: Editorials • surgery • brain • ischemia • revascularization

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

Coronary artery bypass grafting surgery (CABG) has been persuasively shown to prolong life expectancy in a broad spectrum of patients with severe ischemic heart disease.¹ Improvements in the procedure during the past 2 decades have allowed operative mortality rates to fall while disease severity, comorbidity rate, and procedural complexity have increased. In one area, however, evidence of improvement is harder to discern. Careful studies from a number of groups have now clearly shown that CABG is associated with an increased probability of both short- and long-term (5-year) cognitive dysfunction and consequent reduced quality of life.^2,3 The cause of this postoperative cognitive dysfunction is most likely multifactorial, with risk factors classified into 2 broad categories: those that are patient related and those that are procedure related. Predominant patient-related factors include the increasing age of the typical CABG patient and the underlying predisposition of older adult patients to develop cognitive dysfunction after any major operation. For example, the International Study of Postoperative Cognitive Dysfunction found that 26% of patients older than age 60 years who underwent major abdominal or orthopedic surgery experienced cognitive dysfunction 1 week after surgery.⁴

See p 3411

Major risk factors in that study included older age, increased duration of anesthesia, and postoperative respiratory and infectious complications. Only age was a risk factor for persistent cognitive dysfunction; at 3 months, 14% of patients aged 70 years or older experienced cognitive impairment.⁴ In addition, CABG patients typically have extensive atherosclerosis in multiple vascular systems, and even "benign" invasive procedures in . . . [Full Text of this Article]

Related Article:

Neuropsychological Outcome After Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting: Results From the Stent or Surgery (SoS) Trial

Peter Währborg, Jean E. Booth, Tim Clayton, Fiona Nugara, John Pepper, William S. Weintraub, Ulrich Sigwart, Rod H. Stables for the SoS Neuropsychology Substudy Investigators
Circulation 2004 110: 3411-3417. [Abstract] [Full Text]

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