Cerebral dysfunction after coronary artery bypass surgery

Abstract

Cerebral dysfunction after cardiac surgery remains a devastating complication and is growing in importance with our aging populations. Neurological complications following cardiac surgery can be classified broadly as stroke, encephalopathy (including delirium), or postoperative cognitive dysfunction (POCD). These etiologies are caused primary by cerebral emboli, hypoperfusion, or inflammation that has largely been attributed to the use of cardiopulmonary bypass. Preventative operative strategies, such as off-pump coronary artery bypass grafting (CABG), can potentially reduce the incidence of postoperative neurological complications by avoiding manipulation of the ascending aorta. Although off-pump CABG is associated with reduced risk of stroke, there are no convincing differences in POCD between off-pump and on-pump CABG. Recently, the focus of postoperative neurological research has shifted from managing cardiopulmonary bypass to patient-related factors. Identifying changes in brains of aged individuals undergoing cardiac surgery may improve strategies for preventing cerebral dysfunction. Advanced age is associated with more undiagnosed cerebrovascular disease and is a major risk factor for stroke and POCD following cardiac surgery. Preoperative cerebrovascular evaluation and adaptation of surgical strategies will provide preventative approaches for cerebral dysfunction after CABG. This review focuses on recent findings of the relationship between perioperative stress and underlying fragility of the brain in cardiac surgical patients.

The role of Perioperative Surgical Home on health and longevity in society: importance of the surgical prehabilitation program

“…These situations resemble locomotive syndrome and frailty in the elderly and hospitalized patients undergoing surgery can be considered to have a high risk of locomotive syndrome and frailty. In addition, the development of delirium and cognitive dysfunction after surgery further deteriorates the patient's physical status due to increased morbidity and hospital length of stay, especially in elderly patients [16,17].…”

Proceedings of the Iii International Scientific and Practical Conference “Psychological Health of the Person: Life Resource and Life Potential”

“…Stroke incidence after cardiac surgery has been reduced to 1-8%, and delirium incidence to 7-10%, whereas the incidence of cognitive disorders remains 30-80% within one month after surgery, and 10-60% within three-to four months after surgery. However, a significant amount of controversial data is still present in publications on the issue (Goto, & Maekawa, 2014;Trubnikova, Mamontova, Syrova, Maleva, & Barbarash, 2014;Baba, Maekawa, Otomo, Tokunaga, & Oyoshi, 2014).…”

Management of cognition as reported in Japanese historical documents and modern anesthesiology research papers

“…He also reported that postoperative pain management and intensive early rehabilitation seem to be important for the prevention of POCD in elderly patients. Kengo Maekawa showed that assessment of magnetic resonance images of the brain revealed reduced gray matter bilaterally in the medial temporal lobe, together with white matter lesions in the brains of elderly cardiac surgery patients who developed POCD [30,31]. Kazuyoshi Ishida reviewed >100 previous studies and pointed out that many patients undergoing major vascular surgery under deep circulatory arrest or retrograde cerebral perfusion, and an equal or even larger number of patients undergoing surgery with selective cerebral perfusion, seem to develop POCD when compared with patients after coronary artery bypass grafting [32].…”