Neurological and cognitive sequelae of cardiac surgery

Over the last 50 years, heart surgery, and coronary artery bypass grafting (CABG) in particular, has been a remarkable success story. John Gibbon and his wife, who were instrumental in the development of the cardiopulmonary bypass pump, were close family friends of one of us (GMcK), so as a youngster he heard about its early trials and tribulations. Years later, as a neurologist, he became increasingly aware of the neurological problems associated with CABG and other heart surgery procedures. This review is based primarily on our group's prospective analyses of the neurological problems associated with heart surgery at Johns Hopkins Hospital, initiated in 1992, and carried out continuously since that time. We have confined our remarks primarily to CABG and valve surgery, and we do not comment on pediatric heart surgery, aortic surgery, or heart transplantation. We have divided these potential neurologic outcomes as: stroke; encephalopathy; short-term cognitive problems; and long-term cognitive problems, and the incidence of each in our patient population is shown in Fig. 3.1.