Neurocognitive outcomes 3 years after coronary artery bypass graft surgery: a controlled study.

BACKGROUND Cardiopulmonary bypass has been implicated in the late cognitive decline that has been reported after coronary artery bypass graft (CABG) surgery. Because most studies did not include a control group, a causal link of such decline with the use of cardiopulmonary bypass has not been established. METHODS We compared changes in cognitive performance from baseline to 3 years in patients undergoing on-pump CABG (n = 152) with those of three control groups: patients with off-pump surgery (n = 75); with diagnosed coronary artery disease but no surgery (n = 99); and without coronary artery disease risk factors (n = 69). Neuropsychological performance was assessed by standardized tests of attention, language, verbal and visual memory, visuospatial, executive function, and psychomotor and motor speed. RESULTS Relative to their baseline performance, no group had significantly lower performance at 36 months for any of the cognitive domains. From 12 to 36 months, there were no statistically significant differences in the degree of change between the on- and off-pump surgery groups. There was a trend toward mild decline in some cognitive domains, but overall differences among groups in degree of change over time were not statistically significant. CONCLUSIONS We found a mild but nonsignificant trend toward late postoperative cognitive decline for all study groups with coronary artery disease, but no significant differences in the degree of late postoperative cognitive decline after on-pump compared with off-pump surgery. These findings suggest that previously reported late decline after bypass surgery is not specific to use of cardiopulmonary bypass.

[1]  Arlene Fink,et al.  Erratum to: The functional status questionnaire: Reliability and validity when used in primary care , 1986, Journal of General Internal Medicine.

[2]  M. Sakoh,et al.  The prevalence and severity of cerebrovascular disease in patients undergoing cardiovascular surgery. , 2004, Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.

[3]  R. Tibshirani,et al.  Improvements on Cross-Validation: The 632+ Bootstrap Method , 1997 .

[4]  E. Kumral,et al.  Apolipoprotein E ɛ4 Allele and Neurobehavioral Status After On‐Pump Coronary Artery Bypass Grafting , 2005 .

[5]  P. Halligan,et al.  Postoperative hypoxia is a contributory factor to cognitive impairment after cardiac surgery. , 2003, The Journal of thoracic and cardiovascular surgery.

[6]  James Tatoulis,et al.  Neurocognitive outcomes in off-pump versus on-pump bypass surgery: a randomized controlled trial. , 2006, The Annals of thoracic surgery.

[7]  R. Royall,et al.  Cognitive changes 5 years after coronary artery bypass grafting: is there evidence of late decline? , 2001, Archives of neurology.

[8]  H. Nyman,et al.  Cognitive function after on or off pump coronary artery bypass grafting. , 2006, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[9]  Peter Schönknecht,et al.  Prevalence and natural course of aging-associated cognitive decline in a population-based sample of young-old subjects. , 2005, The American journal of psychiatry.

[10]  R Brookmeyer,et al.  Predictors of stroke risk in coronary artery bypass patients. , 1997, The Annals of thoracic surgery.

[11]  T. Manolio,et al.  Stroke risk factors and loss of high cognitive function , 2004, Neurology.

[12]  A. Folsom,et al.  Cardiovascular risk factors and cognitive decline in middle-aged adults , 2001, Neurology.

[13]  E. D. Haan,et al.  Vascular risk factors and cognitive function in a sample of independently living men , 2005, Neurobiology of Aging.

[14]  S. Zeger,et al.  Is there cognitive decline 1 year after CABG? , 2005, Neurology.

[15]  Y. Arai,et al.  Magnetic resonance imaging findings and postoperative neurologic dysfunction in elderly patients undergoing coronary artery bypass grafting. , 2001, The Annals of thoracic surgery.

[16]  Niels D Prins,et al.  Cerebral small-vessel disease and decline in information processing speed, executive function and memory. , 2005, Brain : a journal of neurology.

[17]  R. Palmer,et al.  Normal rates of cognitive change in successful aging: The Freedom House Study , 2005, Journal of the International Neuropsychological Society.

[18]  S. Zeger,et al.  Quantitative methods for tracking cognitive change 3 years after coronary artery bypass surgery. , 2005, The Annals of thoracic surgery.

[19]  S. Zeger,et al.  Cognitive outcomes three years after coronary artery bypass surgery: a comparison of on-pump coronary artery bypass graft surgery and nonsurgical controls. , 2005, The Annals of thoracic surgery.

[20]  K. Sotaniemi,et al.  Long-term cerebral outcome after open-heart surgery. A five-year neuropsychological follow-up study. , 1986 .

[21]  M. Bednar,et al.  Assessment of the emergence of Alzheimer's disease following coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty. , 2005, Journal of Alzheimer's disease : JAD.

[22]  L. Radloff The CES-D Scale , 1977 .

[23]  P. Diggle Analysis of Longitudinal Data , 1995 .

[24]  Mark F. Newman,et al.  Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. , 2001 .

[25]  K. Sotaniemi LONG‐TERM CEREBRAL OUTCOME AFTER OPEN‐HEART SURGERY , 1984, Stroke.

[26]  W. White,et al.  Preliminary report of a genetic basis for cognitive decline after cardiac operations. The Neurologic Outcome Research Group of the Duke Heart Center. , 1997, The Annals of thoracic surgery.

[27]  A. Hofman,et al.  Effect of baseline cognitive function and antihypertensive treatment on cognitive and cardiovascular outcomes: Study on COgnition and Prognosis in the Elderly (SCOPE) , 2005, Alzheimer's & Dementia.

[28]  J. Keith,et al.  Why serial assessments of cardiac surgery patients' neurobehavioral performances are misleading. , 2007, The Annals of thoracic surgery.

[29]  C J Kalkman,et al.  Association between early and three month cognitive outcome after off-pump and on-pump coronary bypass surgery , 2004, Heart.

[30]  J. Cashy,et al.  Stable cognition after coronary artery bypass grafting: comparisons with percutaneous intervention and normal controls. , 2006, The Annals of thoracic surgery.

[31]  S. Newman,et al.  Cognitive change 5 years after coronary artery bypass surgery. , 2003, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[32]  L. Rasmussen,et al.  Cognitive Outcomes in Elderly High-Risk Patients After Off-Pump Versus Conventional Coronary Artery Bypass Grafting: A Randomized Trial , 2006, Circulation.

[33]  W. Baumgartner,et al.  Cognitive changes with coronary artery disease: a prospective study of coronary artery bypass graft patients and nonsurgical controls. , 2003, The Annals of thoracic surgery.

[34]  A. Jette,et al.  The functional status questionnaire , 1986, Journal of General Internal Medicine.

[35]  M. Bolla,et al.  The role of apolipoprotein E in cognitive decline after cardiac operation. , 2001, The Annals of thoracic surgery.

[36]  I. Deary,et al.  Apolipoprotein E and neurocognitive outcome from coronary artery surgery , 2002, Journal of neurology, neurosurgery, and psychiatry.

[37]  H. Christensen,et al.  What Cognitive Changes can be Expected with Normal Ageing? , 2001, The Australian and New Zealand journal of psychiatry.