A comparison of neuropsychologic deficits after extracardiac and intracaradiac surgery.
OBJECTIVE
To compare the incidence of neuropsychologic deficits 1 week and 6 months after coronary artery bypass graft (CABG) surgery (extracardiac) and valve surgery with or without CABG surgery (intracardiac) using reliable change indices to define the incidence of neuropsychologic deficits.


METHODS
Prospective study.


METHODS
Cardiac surgical unit in a university teaching hospital.


METHODS
Patients scheduled for elective multiple-graft (> or =3 grafts) CABG surgery (n = 59), or elective valve surgery (with or without concomitant CABG surgery) (n = 50) and a matched sample of nonsurgical controls (n = 53).


METHODS
Neuropsychologic assessments were performed 1 day before surgery, 7 days and 6 months after surgery.


RESULTS
The 7-day assessment showed no significant differences between valve surgery patients and CABG surgery patients in the incidence of neuropsychologic deficits. When reassessed 6 months postoperatively, the valve group displayed a significantly higher incidence of deficits on the digit symbol test compared with the CABG group (valve 26.7% v CABG 6.8%). In the CABG group, there was a significant change in the incidence of deficits per patient from 7 days to 6 months (p = 0.03) that was not evident in the valve group.


CONCLUSIONS
There are some differences in the neuropsychologic outcome of extracardiac and intracardiac surgery. Patients undergoing isolated CABG surgery showed a greater reduction in the incidence of persisting deficits at 6 months than patients undergoing valve surgery with or without CABG surgery. This finding warrants further investigation, with particular attention to patients undergoing combined valve and coronary artery procedures.
Department of Surgery, Flinders Medical Centre and Flinders University of South Australia, Adelaide.
M J
MJ
Andrew
R A
RA
Baker
J
J
Bennetts
A C
AC
Kneebone
J L
JL
Knight
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology* / Q000523:psychology*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000523:psychology*; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors