Neurocognitive deficit following coronary artery bypass grafting: a prospective study of surgical patients and nonsurgical controls.
BACKGROUND
To objectively measure long-term neurocognitive deficit in patients undergoing coronary artery bypass grafting and compare the findings with nonsurgical controls.


METHODS
We prospectively measured neurocognitive function in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (n = 104; mean age 64.1 years old; EuroSCORE 2.7 [means]). A cohort of age- and sex-matched patients (n = 80; mean age 63.4 years old) served as nonsurgical controls. After CABG, neurocognitive function was serially reevaluated at 7-day (n = 104), 4-month (n = 100), and 3-year follow-up (n = 88). Neurocognitive function was objectively measured by means of cognitive P300 evoked potentials. Additionally, standard psychometric tests were performed (Trailmaking Test A, Mini Mental State Examination).


RESULTS
As compared to preoperative measures (364 +/- 36 ms), cognitive P300 evoked potentials were prolonged (=impaired) at 7-day (381 +/- 36 ms; p = 0.001), 4-month (378 +/- 31 ms; p = 0.08), and 3-year follow-up (379 +/- 35 ms; p = 0.002), respectively. Trailmaking Test A was abnormal, as compared to preoperative, at 3-year follow-up (p < 0.001). Before the operation, surgical patients were fully comparable in P300 measures to nonsurgical controls (363 +/- 32 ms; p = 0.362). Most importantly, throughout the entire postoperative follow-up cognitive measures in surgical patients were prolonged (=impaired) as compared with controls (7-day p = 0.001; 4-month p = 0.002 and 3-year p = 0.003, respectively). In stepwise multivariate regression analysis, neurocognitive deficit at 4-month follow-up (p < 0.001), age (p = 0.012), and persistent atrial fibrillation (p = 0.024) were predictive for long-term neurocognitive deficit at 3-year follow-up.


CONCLUSIONS
As shown by means of objective measures, and in comparison to nonsurgical controls, coronary artery bypass grafting with cardiopulmonary bypass grafting causes long-term neurocognitive deficit.
Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria.
Daniel
D
Zimpfer
Martin
M
Czerny
Ferdinand
F
Vogt
Philipp
P
Schuch
Ludwig
L
Kramer
Ernst
E
Wolner
Michael
M
Grimm
D000368:Aged; D000768:Anesthesia, General; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D018913:Event-Related Potentials, P300; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*