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Stroke, Vol 18, 700-707, Copyright © 1987 by American Heart Association
PJ Shaw, D Bates, NE Cartlidge, JM French, D Heaviside, DG Julian and DA Shaw
As part of a prospective study of the neurologic and neuropsychological
complications of coronary artery bypass graft surgery, 312 patients were
compared with a control group of 50 patients undergoing major surgery for
peripheral vascular disease. The purpose of comparing the 2 groups was to
determine to what extent neurologic complications after heart surgery can
be attributed to cardiopulmonary bypass. The 2 groups were similar with
respect to age, preoperative neurologic and intellectual status, anesthetic
methods, duration of operation, perioperative complications, and time spent
in the intensive therapy unit. Certain potential risk factors for
cerebrovascular disease were more common in the control than the coronary
bypass patients. The important difference between the 2 groups was that
only the latter group underwent cardiopulmonary bypass. In this group 191
of 312 (61%) and 235 of 298 (79%), respectively, developed early neurologic
and neuropsychological complications. By the time of hospital discharge 17%
had neurologic disability and 38% had significant neuropsychological
symptoms. In the control group 9 of 50 (18%) developed neurologic
complications resulting largely from trauma to lower limb sensory nerves.
Two patients developed primitive reflexes. Fifteen of 48 (31%) showed
neuropsychological impairment on 1 or 2 subtest scores. Moderate or severe
intellectual dysfunction was not seen in the control patients in contrast
to the 24% thus affected in the coronary bypass group. The difference in
frequency and severity of central nervous system complications between the
2 groups is likely to reflect cerebral injury resulting from
cardiopulmonary bypass.
ARTICLES
Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery
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