From the Departments of Neurology (A.J., M.N., M.G., J.R., P.M., W.-D.H.)
and Cardiothoracic Surgery (M.H., H.E., E.R. de V.), University of Cologne,
and the Max-Planck Institute for Neurological Research (A.J., M.G., J.K.,
J.R., H.B., W.-D.H.), Cologne, Germany.
Correspondence to Andreas H. Jacobs, MD, Molecular Neurogenetics Unit, Department of Neurology, Massachusetts General Hospital East, Harvard Medical School, 6205 CNY-Building 149–13th St, Charlestown, MA 02129. E-mail Andreas.Jacobs{at}pet.mpin-koeln.mpg.de
Background and
Purpose—High-intensity transient signals (HITS) during cardiac
surgery are capable of causing encephalopathy and cognitive deficits.
This study was undertaken to determine whether intraoperative HITS
cause alterations of neuropsychological function (NPF) and/or cerebral
glucose metabolism (CMRGlc), even in a low-risk patient
group, and whether induced changes are interrelated.
Methods—Eighteen patients without signs of cerebrovascular
disease underwent elective coronary artery bypass grafting
(CABG), and two of these additionally underwent valve replacement in
normothermia. Intraoperatively, HITS were recorded by means of
transcranial Doppler ultrasonography (TCD).
Perioperatively, NPF and CMRGlc were assessed using a
standardized complex test battery and positron emission tomography with
18F-2-fluoro-2-deoxy-D-glucose (FDG-PET),
respectively.
Results—Intraoperatively, the number of HITS ranged from 90 to
1710 per patient and hemisphere, more on the right side than on the
left (P<.05). HITS occurred primarily during
cardiopulmonary bypass (71.3%) and, to a lesser extent, during
aortic manipulation (22.2%). Changes in global and regional CMRGlc
between first (one day preoperatively) and second (8 to 12 days
postoperatively) FDG-PET scans were mild. No correlations were found
between the number of HITS, age of patient, duration of cardiac
ischemia or cardiopulmonary bypass and the changes in
CMRGlc. In patients with recorded HITS and a postoperative decrease
of regional CMRGlc (n=11), the maximal decrease of rCMRGlc in each
hemisphere below the individual global change of CMRGlc correlated with
the number of HITS (r=-0.46, P<.05).
Limitations in NPF occurred 8 to 12 days postoperatively, resolved
within 3 months, and were not found to be correlated to the absolute
number of HITS or changes in CMRGlc.
Conclusions—HITS during cardiac surgery can cause alterations of
both NPF and CMRGlc, even in a low-risk patient group. However, the
number of HITS and changes in NPF and CMRGlc are not necessarily
interrelated, which indicates that (1) the location of brain damage
related to HITS is more important for the development of NPF than is
the absolute number of HITS, and (2) factors in addition to HITS might
contribute to surgery-related brain damage.
© 1998 American Heart Association, Inc.
Original Contributions
Alterations of Neuropsychological Function and Cerebral Glucose Metabolism After Cardiac Surgery Are Not Related Only to Intraoperative Microembolic Events
Key Words: cardiopulmonary bypass • cerebral embolism • neuropsychological tests • tomography, emission computed • ultrasonography, Doppler
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