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June 19, 2002

Cognitive Outcomes Following Cardiopulmonary Bypass

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(23):3077-3079. doi:10.1001/jama.287.23.3077

To the Editor: Dr Van Dijk and colleagues1 demonstrated that patients who received their first CABG without cardiopulmonary bypass (CPB) had a small improvement in the cognitive outcome 3 months after the procedure, but the effects did not persist at 12 months. Cerebral microembolism and hypoperfusion, which are associated with CPB, are the main mechanisms of brain injury in patients undergoing CABG. Microembolic signals detected by transcranial Doppler ultrasound and echocardiography monitoring during CPB can be directly associated with aortic manipulations, but a large proportion of them are thought to represent air bubbles or microparticulate emboli generated from the pump circuit and not completely eliminated by the arterial line filters.2 Off-pump CABG is associated with a marked reduction of the microembolic load during surgery and, therefore, is believed to reduce cognitive impairment in those patients.

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