Short-term and long-term cognitive function and cerebral perfusion in off-pump and on-pump coronary artery bypass patients

• Published in: European journal of cardio-thoracic surgery 2006-01, Vol.29 (1), p.74-81
• Main Authors: Chernov, Vladimir I., Efimova, Nataliya Yu, Efimova, Irina Yu, Akhmedov, Shamil D., Lishmanov, Yuri B.
• Format: Article
• Language: English
• Subjects: Angina Pectoris - physiopathology; Angina Pectoris - surgery; Benzamides - therapeutic use; Brain - blood supply; Brain - diagnostic imaging; Brain - physiopathology; Brain SPECT; Cardiopulmonary bypass; Cerebrovascular Circulation - physiology; Cerebrovascular complications; Cognition; Cognition Disorders - etiology; Cognition Disorders - prevention & control; Cognitive function; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Coronary artery bypass graft surgery; Coronary Artery Bypass, Off-Pump - adverse effects; Coronary Artery Bypass, Off-Pump - methods; Drug Combinations; Female; Hexobendine - therapeutic use; Humans; Male; Memory - physiology; Middle Aged; Neuropsychological Tests; Off-pump coronary revascularization; Postoperative Period; Theophylline - analogs & derivatives; Theophylline - therapeutic use; Time Factors; Tomography, Emission-Computed, Single-Photon - methods
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2005.10.001

Objective: The aim of this study was to evaluate cognitive function, as measured by serial neuropsychological testing, and cerebral perfusion, as measured by brain SPECT scanning in patients with coronary artery diseases (CAD) following off-pump and on-pump coronary artery bypass graft surgery. Besides, the relationship between cerebral blood flow, cognitive functions, surgery parameters, and cardiac function in these patients were estimated. Also, brain-protective effects of instenon were studied. Methods: Brain SPECT and comprehensive neuropsychological testing were performed 1 day before, 10–14 days and 6 months after coronary artery bypass graft surgery (CABG). The study involved 65 patients (62 males and 3 females, mean age 55 ± 2) who underwent CABG with cardiopulmonary bypass (CPB) (43 pts) and off-pump coronary revascularization (OPCAB) using the Octopus stabilization system (22 pts). In 21 cases employing CPB, for prevention of the impairments of cerebral perfusion and cognitive deficit instenon was administered. Results: CABG with the use of extracorporeal circulation is complicated by short-term and long-term neurocognitive dysfunction (in 96 and 55% cases, correspondingly). Also, in the early period after CABG, in 68% patients, decrease in regional cerebral blood flow (rCBF) was found, and after 6 months brain perfusion was lower than the baseline in 55% cases. Relationship between postoperative rCBF changes and the dynamics of cognitive function was found in early period and after 6 months following CABG. Conclusion: The coronary revascularization on beating heart or preventive administration of instenon in CPB patients helps significantly to diminish the risk of cerebrovascular complication.