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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 reported little difference in the cognitive function of patients 12 months after either off-pump or on-pump CABG. This outcome was unexpected since on-pump procedures are associated with aortic cannulation and prolonged extracorporeal perfusion, both of which may shower the brain with emboli. One explanation for this finding, which the authors did not discuss, might be that patients in need of CABG have a high baseline rate of 12-month cognitive decline with or without surgery. This is a testable hypothesis: control groups of patients who are managed without surgery (eg, with drugs only or with drugs and angioplasty) could be assembled and followed up for a year and subjected to the same tests of cognitive function as the intervention groups in this study. Then we might better learn if CABG or some other aspect of these patients' illness is responsible for their cognitive decline over time.