TY - JOUR
T1 - Neurologic outcomes after coronary artery bypass grafting with and without cardiopulmonary bypass
AU - Scarborough, John E.
AU - White, William
AU - Derilus, Frantz E.
AU - Mathew, Joseph P.
AU - Newman, Mark F.
AU - Landolfo, Kevin P.
PY - 2003/1
Y1 - 2003/1
N2 - Neurologic injury, in the form of either stroke or more subtle neurocognitive impairment, is a frequent and potentially devastating complication of coronary artery bypass grafting (CABG). The etiology of CABG-associated neurologic injury is likely multifactorial, with the phenomena of cerebral hypoperfusion and embolism being the major contributors. Several perioperative strategies have been developed in an effort to reduce the incidence of CABG-associated neurologic complications. Hypothermic cerebral perfusion, alpha stat acid-base management, and slow patient rewarming have been shown by several investigators to minimize adverse neurologic sequelae associated with the use of cardiopulmonary bypass. Performing CABG without cardiopulmonary bypass (off-pump CABG), meanwhile, has been shown to reduce the risk of perioperative stroke, especially in high-risk patients such as the elderly. Whether off-pump CABG reduces the incidence of less severe neurocognitive impairment has not yet been clearly established and merits further investigation in the form of large, multicenter, randomized trials. Other technical innovations, such as the use of sutureless and clampless aortic anastomotic devices, also may be able to further minimize the neurologic complications associated with CABG.
AB - Neurologic injury, in the form of either stroke or more subtle neurocognitive impairment, is a frequent and potentially devastating complication of coronary artery bypass grafting (CABG). The etiology of CABG-associated neurologic injury is likely multifactorial, with the phenomena of cerebral hypoperfusion and embolism being the major contributors. Several perioperative strategies have been developed in an effort to reduce the incidence of CABG-associated neurologic complications. Hypothermic cerebral perfusion, alpha stat acid-base management, and slow patient rewarming have been shown by several investigators to minimize adverse neurologic sequelae associated with the use of cardiopulmonary bypass. Performing CABG without cardiopulmonary bypass (off-pump CABG), meanwhile, has been shown to reduce the risk of perioperative stroke, especially in high-risk patients such as the elderly. Whether off-pump CABG reduces the incidence of less severe neurocognitive impairment has not yet been clearly established and merits further investigation in the form of large, multicenter, randomized trials. Other technical innovations, such as the use of sutureless and clampless aortic anastomotic devices, also may be able to further minimize the neurologic complications associated with CABG.
KW - Cardiopulmonary bypass
KW - Cerebral embolism
KW - Coronary artery bypass grafting
KW - Neurocognitive dysfunction
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=0038206855&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0038206855&partnerID=8YFLogxK
U2 - 10.1016/S1043-0679(03)70042-2
DO - 10.1016/S1043-0679(03)70042-2
M3 - Review article
C2 - 12813690
AN - SCOPUS:0038206855
SN - 1043-0679
VL - 15
SP - 52
EP - 62
JO - Seminars in Thoracic and Cardiovascular Surgery
JF - Seminars in Thoracic and Cardiovascular Surgery
IS - 1
ER -