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June 19, 2002

Cognitive Outcomes Following Cardiopulmonary Bypass—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

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

In Reply: We agree with Drs Fouad-Tarazi and Feldschuh that while moderate hemodilution may improve rheology and maintain oxygen delivery, severe hemodilution combined with stenosis of cerebral arteries may contribute to negative cerebral outcomes. However, this hypothesis needs to be formally evaluated. This could be accomplished in a retrospective study investigating the relationship between perioperative hematocrit and stroke, in a design comparable with the study of Wu et al,1 which assessed the association between hematocrit and mortality in patients with myocardial infarction. If a negative impact of severe hemodilution during CABG were confirmed, a formal trial of a more aggressive transfusion regimen would be warranted, in which the effect on subtle cognitive decline could be evaluated.

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