Early neuropsychological functioning of patients following off-pump coronary artery bypass surgery.

摘要

Coronary artery bypass graft (CABG) surgery has been increasingly performed over the decades. Although age- and risk-adjusted mortality after CABG has substantially been reduced since 1990s, the reported prevalence of neuropsychological functional decline in patients after CABG has changed little. Use of the cardiopulmonary bypass pump (CPB) is a possible contributor to this decline, thus “off pump” CABG (OPCAB) surgery without CPB has become an alternative of increasing interest. However, studies of neuropsychological outcomes of OPCAB surgery and correlates of outcome are few. Fifty-four consenting patients (mean age 64.5 years; a majority Caucasian and male) of a leading cardiovascular surgical program at a large Midwestern urban tertiary care center participated in the study. Neuropsychological tests of cognitive and motor functioning were administered within 72 hours preoperatively and between 72 hours and discharge postoperatively. Measures were based on Murkin et al.'s (1995) Statement of Consensus on Assessment of Neurobehavioral Outcomes after Cardiac Surgery. Pre-, intra-, and post-operative data were also collected to identify correlates of neuropsychological outcome. From the preoperative baseline to the postoperative follow-up before discharge, an improvement in the cognitive composite of neuropsychological function was observed. However, a decline in the motor composite of neuropsychological function was observed. The improved cognitive composite may be attributed to the time of measurement, definition of decline, and statistical analyses employed. In multivariate analysis, controlling for the pre-composite cognitive score, the final model showed a decline in the post cognitive composite for increasing age and incidence of atrial fibrillation (F _{3, 40} = 42.97; p .001). Controlling for the pre-composite motor score, declines in the post motor composite score were seen for increasing age and anxiety (F_{3, 35} = 15.83; p .001). It is recommended that the study be replicated with a larger sample and design including a comparison group. Further studies to determine the relationships between neuropsychological outcomes at discharge and long-term follow-up, as well as to establish the implications of results for real-world daily function are recommended.