Neurological manifestations and their predictive risk factors in coronary artery bypass graft surgery with extracorporeal circulation

Abstract

This study reports the leading neurological manifestations subsequent to a coronary artery bypass surgical procedure (CAPS) with attending extracorporeal circulation (ECC). The predictive risk factors for these changes are also reported.Eighty-eight subjects submitted to a coronary artery bypass surgical procedure with extracorporeal circulation at the Instituto do Coração da Faculdade de Medicina da USP were included. A total of 22 (25%) subjects displayed neurological changes. Twelve patients (13.6%) presented encephalopathy, 9 (10.2%) presented a peripheral neuropathy, 4 (4.5%) presented an ischemic stroke and 1 (1.1%) patient presented seizures.A total of 86 distinct pre-, intra-and post-operative variables were examined to determining risk factors for the emergence of neurological complications. In order to assess all possible risk factors, the 22 subjects with a documented neurological dysfunction were added to 2 deceased subjects and these 24 subjects were compared to the complication-free group of subjects. Four subjects with a diagnosis of isolated peripheral neuropathy were included in the complication-free group in order to assess the actual risk factors for CNS complications. Thirty-four subjects sustaining a decrement of one or more points in the MMS score were compared with 51 subjects without any decrement in the MMS. Additionally, 11 subjects sustaining a decrement of 3 or more points in the MMS score were compared to 74 subjects without any decrement in the MMS. Moreover, the association of an altered MMS score and/or other neurological changes were assessed in order to evaluate the presence of a nervous system dysfunction.