title: Early results of a comprehensive operative and perfusion strategy to attenuate the incidence of adverse neurological outcomes in on-pump coronary artery bypass grafting (CABG) patients.
abstract: Adverse neurological events, both focal (Type I) and non-focal (Type II), have been appreciated in postoperative on-pump coronary artery bypass grafting (CABG) patients for many years. Advanced age is a significant risk factor for adverse neurological events following CABG surgery. With full knowledge that our elderly population of patients was at high risk for these untoward neurological events, we adopted a comprehensive operative and perfusion strategy in an attempt to attenuate the incidence of these complications. Our strategy included efforts to minimise the number of emboli generated during the operation, avoid cerebral hypoperfusion, and attenuate the systemic inflammatory response. From 15 August 2002 to 31 December 2005, we performed 355 on-pump CABG operations. The incidence of Type I focal injury was 0/355 (0%), the incidence of Type II non-focal injury was 9/355 (2.5%), and postoperative mortality was 2/355 (0.6%). These results compared favorably to the results predicted by the Society of Thoracic Surgeons' (STS) model, and may suggest efficacy.
authors.affiliation: Division of Cardiac Surgery, Brigham & Women's Hospital/Cape Cod Hospital, Harvard Medical School, Boston, MA, USA. klilly@capecodhealth.org
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Lilly
authors.forename: Jorge M
authors.initials: JM
authors.lastname: Balaguer
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pirundini
authors.forename: Michaela A
authors.initials: MA
authors.lastname: Smith
authors.forename: Gilbert
authors.initials: G
authors.lastname: Connelly
authors.forename: Lorrie Jeanne
authors.initials: LJ
authors.lastname: Campbell
authors.forename: Pauline C
authors.initials: PC
authors.lastname: Philie
authors.forename: Michael
authors.initials: M
authors.lastname: McAdams
authors.forename: William
authors.initials: W
authors.lastname: Riley
authors.forename: Rene
authors.initials: R
authors.lastname: Dekkers
authors.forename: Daniel
authors.initials: D
authors.lastname: Fitzgerald
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Cohn
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Rizzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging; D050197:Atherosclerosis / Q000000981:diagnostic imaging; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002560:Cerebrovascular Circulation; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D020766:Intracranial Embolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014463:Ultrasonography