Abstract
Background:
An alarming incidence (1 % to 83%) of neuropsychological dysfunction has been reported
after Operations using cardiopulmonary bypass (CPB). The present clinical study re-evaluates
these complications with current CPB technology in a strictly selected low-risk group
of coronary artery bypass (CABG) patients. Methods: 76 CABG patients, without history of stroke or internal carotid artery stenosis,
were examined before,5 days after, and 2 months after surgery. A neuropsychological
test battery was employed according to the “Statement of Consensus on Assessment of
Neurobehavioral Outcomes after Cardiac Surgery”. Tests include the Block Design Test
(problem-solving strategies, recognition and analysis of forms), the Trail Making
Test (cognitive achievement at speed), and the Digit Span Test (short-term memory
and memory of figures). Results: Both postoperative test scores were not significantly decreased as compared to preoperative
values. In contrast, neuron specific enolase (NSE) and S100b protein, biochemical
markers of cerebral injury, increased markedly during and immediately after surgery
(NSE preop.: 7.07 ± 2.40ng/ml, 1h postop.: 13.64 ± 4.50 ng/ml, p < 0.001; S100 b preop.:
0.04 ± 0.07 ng/ml, after crossclamp: 0.90 ± 0.69 ng/ml, p < 0.001). One patient displayed
postoperative transitional syndrome, another patient suffered from transitory paresis
and hypesthesia of the left arm, which disappeared during hospital stay. Conclusions: Biochemical markers demonstrate significant postoperative cerebral injury during
and immediately after CPB. However, CPB for CABC does not lead to marked impairment
of neuropsychological scores, and clinically relevant neurological findings were observed
in one patient only.
Key words
Cardiopulmonary bypass - Neuropsychological disorders - Neuropsychological test battery
- S100 b protein - Neuron specific enolase
