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March 20, 2002

Protecting the Brain in Coronary Artery Bypass Graft Surgery

Author Affiliations

Author Affiliations: The Outcomes Research and Assessment Group, Duke Clinical Research Institute (Dr Mark), the Neurologic Outcomes Research Group (Drs Mark and Newman), and the Department of Anesthesiology, Duke University Medical Center (Dr Newman), Durham, NC.

JAMA. 2002;287(11):1448-1450. doi:10.1001/jama.287.11.1448

For much of the 35-year history of coronary artery bypass graft (CABG) surgery, the prevailing belief among cardiovascular physicians was that neurological complications of the procedure were infrequent, consisting primarily of a 1% to 5% incidence of stroke.1 Some patients reported to their physicians that they were "not quite right" intellectually after the procedure, but such problems were not systematically examined and seemed to be uncommon. Using preoperative and postoperative neuropsychological testing, researchers from many centers have now convincingly demonstrated that measurable cognitive dysfunction is actually a common complication of CABG surgery, with an incidence of up to 80% to 90% at hospital discharge.2 This apparent epidemic of operative brain injury has created a major dilemma for the physicians who refer more than 800 000 patients for CABG surgery worldwide each year.3 Because the cognitive dysfunction is often not evident on routine clinical or neurological examination, some physicians have accepted the problem as a small but necessary trade off in the quest to improve survival and functional status. However, some researchers have argued that this problem is a major reason the CABG procedure needs to be completely reengineered.

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