TY - JOUR
T1 - Neurobehavioural sequelae of cardiopulmonary bypass
AU - Selnes, Ola A.
AU - Goldsborough, Maura A.
AU - Borowicz, Louis M.
AU - McKhann, Guy
N1 - Funding Information:
Our research was supported by NIH grant NS-35610; the Charles A Dana Foundation; the Research Network on Successful Aging of the John D and Catherine T MacArthur Foundation; and the Seaver Institute. We thank Cheryl Enger and Shirley Quaskey for their statistical advice; Dixon Moody, John Murkin, Donald Stump, Mark F Newman, and Roman DeSanctis for their helpful suggestions on an earlier draft of this paper; and Pamela Talalay for her valuable input and expert editorial advice during all stages of the paper's preparation.
PY - 1999/5/8
Y1 - 1999/5/8
N2 - The development of coronary artery bypass grafting (CABG) and its effect on angina is the product of a series of technical and scientific advances. Despite these advances, however, adverse neurobehavioural outcomes continue to occur. Stroke is the most serious complication of CABG, but studies that have identified demographic and medical risk factors available before surgery are an important advance. Short-term cognitive deficits are common after CABG, but may not be specific to this procedure. However, deficits in some cognitive areas such as visuoconstruction persist over time, and may reflect parieto-occipital watershed area injury secondary to hypoperfusion or embolic factors. Risk factors for cognitive decline may be time dependent, with short-term studies identifying factors that differ from those of long-term studies. Patients with depression before surgery are likely to have persistent depression afterwards. However, depression does not account for the cognitive decline after CABG. Since CABG is increasingly done in older patients with more comorbidity, the challenge is to identify patients at risk of adverse neurocognitive outcomes and to protect them by modification of the surgical procedure or by effective medical therapy.
AB - The development of coronary artery bypass grafting (CABG) and its effect on angina is the product of a series of technical and scientific advances. Despite these advances, however, adverse neurobehavioural outcomes continue to occur. Stroke is the most serious complication of CABG, but studies that have identified demographic and medical risk factors available before surgery are an important advance. Short-term cognitive deficits are common after CABG, but may not be specific to this procedure. However, deficits in some cognitive areas such as visuoconstruction persist over time, and may reflect parieto-occipital watershed area injury secondary to hypoperfusion or embolic factors. Risk factors for cognitive decline may be time dependent, with short-term studies identifying factors that differ from those of long-term studies. Patients with depression before surgery are likely to have persistent depression afterwards. However, depression does not account for the cognitive decline after CABG. Since CABG is increasingly done in older patients with more comorbidity, the challenge is to identify patients at risk of adverse neurocognitive outcomes and to protect them by modification of the surgical procedure or by effective medical therapy.
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U2 - 10.1016/S0140-6736(98)07576-X
DO - 10.1016/S0140-6736(98)07576-X
M3 - Review article
C2 - 10334272
AN - SCOPUS:0033535763
SN - 0140-6736
VL - 353
SP - 1601
EP - 1606
JO - Lancet
JF - Lancet
IS - 9164
ER -