title: Early neurological complications after coronary artery bypass grafting and valve surgery in octogenarians.
abstract: OBJECTIVE
  To determine the incidence and risk factors for neurological events complicating cardiac surgery, and the implications for operative outcome in octogenarians.
  
  
  METHODS
  Of 6791 who underwent primary on-pump CABG and/or valve surgery from 1998 through 2006, 383 were aged > or =80 years. Neurological complications, classified as reversible or permanent, were investigated by head CT scan in patients who did not recover soon after an event.
  
  
  RESULTS
  There were more females (47% vs 26%, p<0.0001) among octogenarians (n=383, median age 82 years) than among younger patients (n=6408, median age 66 years). Controlled heart failure, NYHA class III/IV and chronic obstructive pulmonary disease were more prevalent in octogenarians while preoperative myocardial infarction was predominant in younger patients. Octogenarians were at higher operative risk (median EuroScore 6 vs 2, p<0.0001). Operative procedures differed between octogenarians and younger patients (p<0.0001); respective frequencies were 45% vs 77% for CABG, 26% vs 10% for AVR, and 23% vs 6% for AVR+CABG. Mortality was higher for octogenarians (8.9% vs 2.1, p<0.0001). Early neurological complications observed in 3.9% of the entire study population were mostly reversible (3.2%). Age > or =80 years (odds ratio [OR] 2.82, 95% confidence interval [CI] 1.89-4.21, p<0.0001), prior cerebrovascular disease (OR 2.23, 95% CI 1.56-3.18, p<0.0001), AVR+CABG (OR 2.92, 95% CI 1.60-5.33, p<0.0001) and MVR+CABG (OR 4.77, 95% CI 2.10-10.85, p<0.0001) were predictive of neurological complications. More octogenarians experienced neurological events (p<0.0001): overall 12.8% vs 3.4%, reversible 11.5% vs 2.8%, permanent 1.3% vs 0.6%. Among octogenarians, neurological complication was associated with elevated operative mortality (18% vs 8% for those without neurological complication, p=0.03), and prolonged ventilation, intensive care stay and hospitalisation. Predictors of neurological complications in octogenarians were blood and/or blood product transfusion (OR 3.60, 95% CI 1.56-8.32, p=0.003) and NYHA class III/IV (OR 7.6, 95% CI 1.47-39.70, p=0.02).
  
  
  CONCLUSIONS
  Octogenarians undergoing on-pump CABG and/or valve repair/replacement are at higher risk of neurological dysfunction, from which the majority recover fully. The adverse implications for operative mortality and morbidity, however, are profound. Blood product transfusion which has a powerful correlation with neurological complication should be reduced by rigorous haemostasis with parsimonious use of sealants when appropriate.
authors.affiliation: Castle Hill Hospital, Kingston-Upon-Hull, East Yorkshire, United Kingdom. dngaage@yahoo.com
authors.forename: Dumbor L
authors.initials: DL
authors.lastname: Ngaage
authors.forename: Michael E
authors.initials: ME
authors.lastname: Cowen
authors.forename: Steven
authors.initials: S
authors.lastname: Griffin
authors.forename: Levant
authors.initials: L
authors.lastname: Guvendik
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Cale
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000523:psychology; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000523:psychology; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000592:standards; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications / Q000517:prevention & control / Q000523:psychology; D011237:Predictive Value of Tests; D016896:Treatment Outcome