Central nervous system complications of coronary artery bypass graft surgery: prospective analysis of 421 patients.

A prospective analysis of 421 patients undergoing coronary artery bypass graft (CABG) surgery as the sole cardiac procedure was carried out to assess the frequency of central nervous system (CNS) complications. In all, 451 variables were assessed in each patient. Stroke occurred in 5.2% but was severe in only 2%. Prolonged encephalopathy occurred in 11.6% but usually resolved before discharge. No statistically significant pre- or intraoperative risk variables for CNS complications were found; specifically, age or pump times in excess of two hours were not significant factors. Postoperative use of an intraaortic balloon pump and pressor agents were significantly correlated with prolonged encephalopathy. The frequency of CNS injury in CABG surgery is similar to that in other forms of open heart surgery, and there has been little change in the frequency of CNS complications over the past seven years. Possible mechanisms of CNS damage during CABG surgery are discussed.

[1]  F. Loop,et al.  Mechanism and frequency of brachial plexus injury in open-heart surgery: a prospective analysis. , 1983, The Annals of thoracic surgery.

[2]  L. Wechsler,et al.  Carotid bruit and the risk of stroke in elective surgery. , 1982, The New England journal of medicine.

[3]  F. Loop,et al.  Peripheral nervous system complications of coronary artery bypass graft surgery , 1982, Annals of neurology.

[4]  J. Selhorst,et al.  Ischemic optic neuropathy , 1982, Neurology.

[5]  H. Hurtig,et al.  Neurologic complications of coronary artery bypass grafting , 1981, Neurology.

[6]  R. Barnes,et al.  Asymptomatic Carotid Disease in the Cardiovascular Surgical Patient: Is Prophylactic Endarterectomy Necessary? , 1981, Stroke.

[7]  S. Nomoto,et al.  Subclinical changes in brain morphology following cardiac operations as reflected by computed tomographic scans of the brain. , 1981, The Journal of thoracic and cardiovascular surgery.

[8]  E. Blackstone,et al.  Complement activation during cardiopulmonary bypass: evidence for generation of C3a and C5a anaphylatoxins. , 1981, The New England journal of medicine.

[9]  J. White.  Complement activation during cardiopulmonary bypass. , 1981, The New England journal of medicine.

[10]  W. Turnipseed,et al.  Postoperative Stroke in Cardiac and Peripheral Vascular Disease , 1980, Annals of surgery.

[11]  M. Albin,et al.  Postoperative seizure activity following enflurane anesthesia. , 1980, Anesthesiology.

[12]  R. Fariello,et al.  Diagnostic activation of epileptogenic foci by enflurane. , 1980, Anesthesiology.

[13]  R. Fariello.  Epileptogenic properties of enflurane and their clinical interpretation. , 1980, Electroencephalography and clinical neurophysiology.

[14]  M. J. Moore,et al.  Complement-induced granulocyte aggregation: an unsuspected mechanism of disease. , 1980, The New England journal of medicine.

[15]  M. Hilberman,et al.  Neurologic dysfunction following cardiac operation with low-flow, low-pressure cardiopulmonary bypass. , 1980, The Journal of thoracic and cardiovascular surgery.

[16]  R. Colman,et al.  Thromboxane synthesis and platelet secretion during cardiopulmonary bypass with bubble oxygenator. , 1980, The Journal of thoracic and cardiovascular surgery.

[17]  M. Wholey,et al.  Percutaneous transluminal angioplasty in the management of occlusive disease involving the coronary arteries and saphenous vein bypass grafts: preliminary results. , 1980, The Journal of thoracic and cardiovascular surgery.

[18]  F. Loop,et al.  An 11 Year Evolution of Coronary Arterial Surgery (1967–1978) , 1979, Annals of surgery.

[19]  S. R. Lin,et al.  Effect of dextran on cerebral function and blood after cardiac arrest. An experimental study on the dog. , 1979, Stroke.

[20]  Å. Wåhlin,et al.  EEG‐Changes during General Anaesthesia with Enflurane (Efrane®) in Comparison with Ether , 1978, Acta anaesthesiologica Scandinavica.

[21]  W. Evans,et al.  The significance of asymptomatic unilateral carotid bruits in preoperative patients. , 1978, Surgery.

[22]  J. Willerson,et al.  Creatine kinase BB isoenzyme levels by radioimmunoassay in patients with neurological disease , 1978, Annals of Neurology.

[23]  M. Kairaluoma,et al.  Calcium microemboli and microfilters in valve operations. , 1977, The Annals of thoracic surgery.

[24]  W. Stewart,et al.  Carotid bruit as a risk factor in aortoiliac reconstruction. , 1977, Surgery.

[25]  R. Hinkley.  Microtubule-macrotubule transformations induced by volatile anesthetics. Mechanism of macrotubule assembly. , 1976, Journal of ultrastructure research.

[26]  D. Cosgrove,et al.  Post-hospital course and complications following coronary bypass surgery. , 1976, Cleveland Clinic quarterly.

[27]  G. Hutchins,et al.  Fatal cerebral atheromatous embolization after cardiopulmonary bypass. , 1976, The Journal of thoracic and cardiovascular surgery.

[28]  F. Loop,et al.  Events related to microembolism during extracorporeal perfusion in man: effectiveness of in-line filtration recorded by ultrasound. , 1976, The Annals of thoracic surgery.

[29]  S. Tsung.  Creatine kinase isoenzyme patterns in human tissue obtained at surgery. , 1976, Clinical chemistry.

[30]  P. Hansotia,et al.  Prognostic value of electroencephalography in cardiac surgery. , 1975, The Annals of thoracic surgery.

[31]  M. Branthwaite.  Prevention of neurological damage during open-heart surgery. , 1973, Thorax.

[32]  D. Cannom,et al.  The Long‐Term Follow‐Up of Patients Undergoing Saphenous Vein Bypass Surgery , 1974, Circulation.

[33]  J. Hutchinson,et al.  Coronary bypass grafting in 376 consecutive patients, with three operative deaths. , 1974, The Journal of thoracic and cardiovascular surgery.

[34]  M. Branthwaite.  Detection of neurological damage during open-heart surgery , 1973, Thorax.

[35]  R. Treiman,et al.  Carotid bruit. Significance in patients undergoing an abdominal aortic operation. , 1973, Archives of surgery.

[36]  D. Freyhan.  [Psychiatric complications of open heart surgery]. , 1973, Actas luso-espanolas de neurologia, psiquiatria y ciencias afines.

[37]  M. Branthwaite.  Neurological damage related to open-heart surgery , 1972, Thorax.

[38]  M. Charlton,et al.  Psychiatric complications of open-heart surgery. A re-examination. , 1970, The New England journal of medicine.

[39]  H. Tufo,et al.  Central nervous system dysfunction following open-heart surgery. , 1970, JAMA.

[40]  H. Tufo,et al.  Neurological abnormalities following open-heart surgery. , 1969, The Journal of thoracic and cardiovascular surgery.

[41]  J. Hill,et al.  Neuropathological manifestations of cardiac surgery. , 1969, The Annals of thoracic surgery.