Beating heart surgery: why expect less central nervous system morbidity?

• Published in: The Annals of thoracic surgery Vol. 68; no. 4; pp. 1498 - 1501
• Main Authors: Murkin, John M, Boyd, W.Douglas, Ganapathy, Sugantha, Adams, Sandra J, Peterson, Rhonda C
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.10.1999; Elsevier Science
• Subjects: Biological and medical sciences; Cardiopulmonary Bypass; Coronary Artery Bypass - methods; Heart Arrest, Induced; Humans; Medical sciences; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Risk Factors; Stroke - etiology; Stroke - prevention & control; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Human; Nervous system diseases; Cognitive disorder; Cardiovascular disease; Coronary heart disease; Cerebral disorder; Vascular disease; Prevention; Treatment; Aortocoronary; Ischemia; Bypass; Surgery; Central nervous system disease; Complication; Technique; Cerebrovascular disease; Brain (vertebrata)
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(99)00953-4

Background. The incidence and etiology of brain dysfunction after conventional coronary artery bypass surgery using cardiopulmonary bypass (CPB) are reviewed. Methods. Stroke rates and incidences of cognitive dysfunction from various studies are considered. Mechanisms of injury including cerebral embolization as detected by transcranial Doppler and retinal angiography, and imaging-based evidence for postoperative cerebral edema, are discussed. Preliminary results from a prospective clinical trial assessing cognitive dysfunction after beating heart versus conventional coronary artery bypass with CPB are discussed. Results. Initial evidence for lower overall postoperative morbidity, and for a lower incidence of cognitive dysfunction specifically, after nonpump coronary revascularization is presented. Conclusions. Beating heart surgery results in less potential for generation of cerebral emboli and appears to produce a lower incidence of cognitive dysfunction in both short- and intermediate-term postoperative follow-up periods as compared with conventional coronary artery bypass surgery using CPB.