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.
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