Neuropsychological functioning 3-5 years after coronary artery bypass grafting: does the pump make a difference?
OBJECTIVE
Neurocognitive sequelae after coronary artery bypass grafting (CABG) are frequently reported. The present study investigated the possible difference between on- and off-pump CABG patients in a long-term perspective.


METHODS
We administered seven standardized neuropsychological tests 1 day before, 6 days after, 6 months after and 3-5 years after CABG. We measured intra-operative high intensity transient signals (HITS) as a reflection of embolic load by transcranial Doppler ultrasonography.


RESULTS
Of the 74 patients originally recruited, 54 of the patients (73%) (mean age 59 years+/-7.5 years) completed the neuropsychological battery. Cognitive decline was defined as 20% decline on two or more tests. Three to 5 years after the operation, 30% of the patients showed neurocognitive problems in domains of non-verbal immediate memory and attention, speed for visual search, visual attention and mental flexibility. Neither difference in frequency of cognitive dysfunction nor a difference in evolution over the 5 year time period between on- and off-pump patients was observed. No significant predictors for cognitive decline were found.


CONCLUSIONS
Three to 5 years after the CABG surgery no difference in neurocognitive deficits is found between on- and off-pump CABG patients, indicating that the extracorporeal circulation (ECC) may not be the main cause of late neuropsychological decline.
Stroobant
Nathalie
N
Centre for Cardiac Surgery, University Hospital Ghent, De Pintelaan 185, Ghent, Belgium. Nathalie.Stroobant@ugent.be
van Nooten
Guido
G
De Bacquer
Dirk
D
Van Belleghem
Yves
Y
Vingerhoets
Guy
G
D000367:Age Factors; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003072:Cognition Disorders / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007360:Intelligence; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D018579:Patient Selection; D012307:Risk Factors; D017585:Ultrasonography, Doppler, Transcranial