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European Journal of Cardio-Thoracic Surgery, Vol 3, 216-221, Copyright © 1989 by European Association for Cardio-thoracic Surgery
T Treasure, PL Smith, S Newman, A Schneidau, P Joseph, P Ell and MJ Harrison
Patients undergoing routine coronary artery surgery (N = 76) were compared
with those undergoing other major operations (N = 29) in a prospective
multidisciplinary study designed to define the incidence of neurological
and psychological sequelae. The preoperative state of the carotid and
vertebral arteries was defined by digital subtraction angiography. Changes
in clinical neurological examination, detailed neuropsychological testing,
psychiatric assessment and cerebral blood flow were measured. All
preoperative studies were repeated 8 days and 8 weeks after surgery.
Clinical neurological examination was repeated in addition on the 1st
postoperative day. New focal neurological signs were found in 8% of the
cardiac patients and none of the comparison group 24 h after operation (P =
0.9). Global transient neurological dysfunction occurred in 59% of the
coronary group in the 1st postoperative day compared with 21% in other
forms of surgery (P = 0.0007) but this correlated with postoperative
narcotic and sedative drugs. A deterioration in neuropsychological
performance was detectable in 73% of coronary cases at 8 days which was
more likely to occur with increasing age, longer bypass time and lower
perfusion pressure, but similar neuropsychological changes also occurred in
50% of the comparison group. By 8 weeks, there was a significant
improvement in the cardiac patients (37%, P less than 0.001) but not in the
other group. Cerebral blood flow was reduced at 8 days in the coronary
bypass patients but not in the comparison group suggesting that the
mechanism of cerebral change may be different in the two groups.
ARTICLES
Impairment of cerebral function following cardiac and other major surgery
Middlesex Hospital, London, UK.
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