81:(OPCAB)—essentially establishing controls to compare the incidence of neurocognitive decline in CABG with and without the use of CPB. A small study (60 patients total, 30 in each treatment arm) by Zamvar et al. demonstrated neurocognitive impairment was worse for the on-pump group both 1 week and 10 weeks postoperatively. A larger study (281 patients total) by Van Dijk et al. showed CABG surgery without cardiopulmonary bypass improved cognitive outcomes 3 months after the procedure, but the effects were limited and became negligible at 12 months. Furthermore, the Van Dijk study showed no difference between the on-pump and off-pump groups in quality of life,
110:(CAD) to heart-healthy controls (people with no cardiac risk factors). People with CAD were subdivided into treatment with CABG, OPCAB and non-surgical medical management. The three groups with CAD all performed significantly lower at baseline than the heart-healthy controls. All groups improved by 3 months, and there were minimal intrasubject changes from 3 to 12 months. No one consistent difference between the CABG and off-pump patients was observed. The authors concluded patients with long-standing coronary artery disease have some degree of cognitive dysfunction secondary to
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differ from a comparable nonsurgical control group with coronary artery disease 1 or 3 years after baseline examination. This finding suggests that late cognitive decline after coronary artery bypass grafting previously reported by Newman et al. may not be specific to the use of cardiopulmonary bypass, but may also occur in patients with very similar risk factors for cardiovascular and cerebrovascular disease.
42:. Symptoms of postperfusion syndrome are subtle and include defects associated with attention, concentration, short-term memory, fine motor function, and speed of mental and motor responses. Studies have shown a high incidence of neurocognitive deficit soon after surgery, but the deficits are often transient with no permanent neurological impairment.
131:, a documentary about the condition. The film explores the experiences of eight patients following major heart surgery, describing their experiences with postperfusion syndrome. The filmmaker Andrew Pike experienced pumphead himself, following open-heart surgery in 2011. The film introduces the concept of
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disease before surgery; there is no evidence the cognitive test performance of bypass surgery patients differed from similar control groups with coronary artery disease over a 12-month follow-up period. A related study by Selnes et al. concluded patients with coronary artery bypass grafting did not
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Given the above studies, there is high incidence of neurocognitive deficit shortly after bypass surgery, but evidence is less clear about long-term neurological impairment. Controlled "on-pump" versus "off-pump" cardiac surgery has only been studied in the setting of CABG and is not necessarily
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Van Dijk D, Jansen E, Hijman R, Nierich A, Diephuis J, Moons K, Lahpor J, Borst C, Keizer A, Nathoe H, Grobbee D, De
Jaegere P, Kalkman C (2002). "Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial".
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Selnes O, Grega M, Borowicz L, Barry S, Zeger S, Baumgartner W, McKhann G (2005). "Cognitive outcomes three years after coronary artery bypass surgery: a comparison of on-pump coronary artery bypass graft surgery and nonsurgical controls".
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at 3 and 12 months. A study by Jenson et al. published in
Circulation found no significant difference in the incidence of cognitive dysfunction 3 months after either OPCAB or conventional on-pump CABG.
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McKhann G, Grega M, Borowicz L, Bailey M, Barry S, Zeger S, Baumgartner W, Selnes O (2005). "Is there cognitive decline 1 year after CABG? Comparison with surgical and nonsurgical controls".
74:. Also, the statistical calculation of cognitive decline has been demonstrated as the least reliable due to practice effects, measurement error and the regression to the mean phenomenon.
62:) and over time (36 percent six weeks, 24 percent at six months, and 42 percent at five years). This study shows an association of neurocognitive decline with CABG, but does not show
352:"Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: prospective randomised controlled trial"
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311:"Assessment of statistical change criteria used to define significant change in neuropsychological test performance following cardiac surgery"
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547:"Cognitive outcomes in elderly high-risk patients after off-pump versus conventional coronary artery bypass grafting: a randomized trial"
187:"Cognitive outcomes in elderly high-risk patients after off-pump versus conventional coronary artery bypass grafting: a randomized trial"
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Newman M, Kirchner J, Phillips-Bute B, Gaver V, Grocott H, Jones R, Mark D, Reves J, Blumenthal J (2001).
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generalizable to other types of cardiac surgery. Recent advancements in transcatheter and
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270:"Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery"
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Zamvar V, Williams D, Hall J, Payne N, Cann C, Young K, Karthikeyan S, Dunne J (2002).
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may soon allow comparison of other types of cardiac surgery with and without CPB.
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A study by McKhann et al. compared the neurocognitive outcome of people with
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This article is about the mental condition. For the term in engineering, see
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Jensen B, Hughes P, Rasmussen L, Pedersen P, SteinbrĂĽchel D (2006).
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Jensen B, Hughes P, Rasmussen L, Pedersen P, SteinbrĂĽchel D (2006).
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Raymond P, Hinton-Bayre A, Radel M, Ray M, Marsh N (2006).
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Neurocognitive deficit as a consequence of vascular disease
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showed an increased incidence of cognitive decline after
58:(CABG), both immediately (53 percent at discharge from
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512:"Can cognition survive heart surgery?"
155:Post-chemotherapy cognitive impairment
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150:Postoperative cognitive dysfunction
413:10.1212/01.wnl.0000175220.78475.99
123:In 2020, Australian film director
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564:10.1161/CIRCULATIONAHA.105.587931
529:10.1161/CIRCULATIONAHA.106.632711
204:10.1161/CIRCULATIONAHA.105.587931
457:10.1016/j.athoracsur.2004.10.011
145:Heparin-coated blood oxygenator
79:off-pump coronary artery bypass
487:. Ronin Films. 16 October 2020
96:percutaneous valve replacement
56:coronary artery bypass surgery
52:Duke University Medical Center
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580:Cardiac Surgery In The Adult
50:A study by Newman et al. at
328:10.1016/j.ejcts.2005.10.016
287:10.1056/NEJM200102083440601
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34:impairments attributed to
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368:10.1136/bmj.325.7375.1268
30:", is a constellation of
510:Samuels MA (June 2006).
244:10.1001/jama.287.11.1405
315:Eur J Cardiothorac Surg
108:coronary artery disease
599:Neurological disorders
36:cardiopulmonary bypass
24:Postperfusion syndrome
133:post-traumatic growth
482:"Pumphead Press Kit"
66:; the study lacks a
18:Bernoulli's equation
161:Vasoplegic syndrome
157:(aka "chemo brain")
85:rate, or all-cause
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551:Circulation
516:Circulation
191:Circulation
125:Andrew Pike
593:Categories
491:18 January
167:References
609:Syndromes
401:Neurology
127:released
87:mortality
64:causation
573:16769915
538:16785349
465:15797050
429:21972340
421:16107605
386:12458242
337:16337395
296:11172175
252:11903027
213:16769915
139:See also
129:Pumphead
60:hospital
46:Evidence
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232:JAMA
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559:doi
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