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Neuropsychological functioning 3–5 years after coronary artery bypass grafting: does the pump make a difference?

^a Centre for Cardiac Surgery, University Hospital Ghent, Belgium
^b Laboratory for Neuropsychology, Department of Internal Medicine - Section Neurology, Ghent University, Belgium
^c Department of Public Health, Ghent University, Belgium

Received 10 September 2007; received in revised form 16 April 2008; accepted 5 May 2008.

^_* Corresponding author. Address: Laboratory for Neuropsychology, Department of Internal Medicine-Section Neurology, Ghent University Hospital, 4K3, De Pintelaan 185, B-9000 Ghent, Belgium. Tel.: +32 9 2404545; fax: +32 9 2404555. (Email: Nathalie.Stroobant{at}ugent.be).

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.

Key Words: Coronary artery bypass grafting • Cognitive brain function • Neuropsychology • Cardiopulmonary bypass • Off-pump surgery