Neurocognitive outcomes of cardiac surgery

摘要

SINCE THE EARLY PERIOD of modern cardiac surgery, it has been recognized that some patients experience severe neurologic complications due to cerebral ischemic injury. Additionally, autopsy studies of patients who died shortly after cardiac surgery due to cardiovascular causes without apparent neurologic deficits exhibited cerebral ischemic lesions. The authors proposed that mild cerebral ischemic injuries also may exist in surgical survivors who exhibit no apparent neurologic deficits or only transient neurologic disturbance. Now, it is understood that there is a range of neurologic complications following cardiac surgery, and they are classified by the American College of Cardiology/American Heart Association into 2 types: type 1 consists of major focal neurologic deficits, stupor, and coma; type 2 consists of milder, more diffuse deficits without evidence of focal injury, including delirium and deterioration of cognitive function. Starting in the 1980s, researchers began using neuropsychological testing to assess milder forms of neurologic deficits following cardiac surgery and found that many patients exhibited declines in neurocog-nitive test performance.