We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Protecting the Brain in Coronary Artery Bypass Graft Surgery

Daniel B. Mark, MD, MPH; Mark F. Newman, MD
JAMA. 2002;287(11):1448-1450. doi:10.1001/jama.287.11.1448.
Text Size: A A A
Published online


For much of the 35-year history of coronary artery bypass graft (CABG) surgery, the prevailing belief among cardiovascular physicians was that neurological complications of the procedure were infrequent, consisting primarily of a 1% to 5% incidence of stroke.1 Some patients reported to their physicians that they were "not quite right" intellectually after the procedure, but such problems were not systematically examined and seemed to be uncommon. Using preoperative and postoperative neuropsychological testing, researchers from many centers have now convincingly demonstrated that measurable cognitive dysfunction is actually a common complication of CABG surgery, with an incidence of up to 80% to 90% at hospital discharge.2 This apparent epidemic of operative brain injury has created a major dilemma for the physicians who refer more than 800 000 patients for CABG surgery worldwide each year.3 Because the cognitive dysfunction is often not evident on routine clinical or neurological examination, some physicians have accepted the problem as a small but necessary trade off in the quest to improve survival and functional status. However, some researchers have argued that this problem is a major reason the CABG procedure needs to be completely reengineered.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

26 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed