Investigation of factors relating to neuropsychological change following cardiac surgery

• Published in: Perfusion 2007-01, Vol.22 (1), p.27-33
• Main Authors: Raymond, Paul D, Radel, Michael, Ray, Michael J, Hinton-Bayre, Anton D, Marsh, Neville A
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Cognition Disorders - diagnosis; Cognition Disorders - etiology; Coronary Artery Bypass - adverse effects; Elective Surgical Procedures; Female; Heparin - blood; Humans; Male; Middle Aged; Neuropsychological Tests; Peptide Fragments - blood; Postoperative Period; Prothrombin; Risk Factors
• ISSN: 0267-6591; 1477-111X
• DOI: 10.1177/0267659107077952

Background. An analysis of neuropsychological impairment following cardiopulmonary bypass was performed in 55 patients undergoing elective coronary artery bypass grafting. Methods. Neurocognitive function was measured preoperatively using the MicroCog: Assessment of Cognitive Functioning computer-based testing tool. Testing was repeated in the postoperative period immediately prior to discharge from hospital. Analysis of significant score decline was performed using the standardised regression-based technique. A patient was classified as overall impaired when ≥20% of test scores were significantly impaired. The proposed marker of neurological damage S-100β was also used. Prothrombin Fragment 1+2 (F1+2) was measured as a marker of thrombin development to test the hypothesis that excessive haemostatic activation may lead to thromboembolic damage to the brain. Results and Conclusions. 32.7% of patients were classified as significantly impaired. No relationship was detected between F1+2 and any neuropsychological test score; however, the study was limited due to small sample size. F1+2 levels were higher in patients undergoing prolonged bypass times. Neuropsychological decline was significantly correlated with patient age, suggesting a degree of caution is warranted when operating on an elderly cohort. An unexpected relationship was detected between higher heparin concentrations and increased risk of neuropsychological impairment; however, this requires re-evaluation. Perfusion (2007) 22, 27—33.