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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 1510-1517, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
KJ Tuman, RJ McCarthy, H Najafi and AD Ivankovich
Two thousand patients undergoing coronary artery bypass grafting with
cardiopulmonary bypass were prospectively studied to compare the influence
of age on the incidence of neurologic, cardiac, and other complications.
Postoperative neurologic events were found in 56 (2.8%) patients, with an
incidence in patients > or = 75 years (8.9%) more than twice that of
patients 65 to 74 (3.6%) and nine times larger than in patients < 65
(0.9%). Cardiac complications did not differ between age groups except for
low cardiac output state, which occurred 1.7 times more frequently in
patients > or = 75 years compared with those < 65. Patients with
postoperative neurologic events had a ninefold increase in mortality--35.7%
versus 4.0%. Logistic regression analysis demonstrate the most important
predictors of a postoperative neurologic event to be age, preoperative
neurologic abnormality, recent myocardial infarction, and duration of
cardiopulmonary bypass. The risk of neurologic complications increases
disproportionately to the risk of cardiac complications in the elderly
undergoing coronary artery bypass grafting with cardiopulmonary bypass.
Despite neurologic improvement (32 of 56 patients), a postoperative
neurologic event was second only to low cardiac output state as the
postoperative complication most highly associated with in-hospital death.
These results are important for decisions regarding selection of candidates
for coronary artery bypass grafting and for prediction of surgical outcome.
ARTICLES
Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations
Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612.
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W. R. Brown, D. M. Moody, V. R. Challa, D. A. Stump, and J. W. Hammon Longer Duration of Cardiopulmonary Bypass Is Associated With Greater Numbers of Cerebral Microemboli Stroke, March 1, 2000; 31(3): 707 - 713. [Abstract] [Full Text] [PDF]
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J. D Fonger Integrated myocardial revascularization Eur. J. Cardiothorac. Surg., November 1, 1999; 16(suppl_2): S12 - S17. [Abstract] [Full Text] [PDF]
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K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]
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J. M. Murkin, W. D. Boyd, S. Ganapathy, S. J. Adams, and R. C. Peterson Beating heart surgery: why expect less central nervous system morbidity? Ann. Thorac. Surg., October 1, 1999; 68(4): 1498 - 1501. [Abstract] [Full Text] [PDF]
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J. P. Gott, V. H. Thourani, C. E. Wright, W. M. Brown III, A. B. Adams, G. M. Skardasis, W. M. McKinnon, P. M. Battey, and R. A. Guyton Risk neutralization in cardiac operations: detection and treatment of associated carotid disease Ann. Thorac. Surg., September 1, 1999; 68(3): 850 - 856. [Abstract] [Full Text] [PDF]
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C. W. Hogue Jr, S. F. Murphy, K. B. Schechtman, and V. G. Davila-Roman Risk Factors for Early or Delayed Stroke After Cardiac Surgery Circulation, August 10, 1999; 100(6): 642 - 647. [Abstract] [Full Text] [PDF]
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G. H. Almassi, T. Sommers, T. E. Moritz, A. L. W. Shroyer, M. J. London, W. G. Henderson, G. K. Sethi, F. L. Grover, and K. E. Hammermeister Stroke in cardiac surgical patients: determinants and outcome Ann. Thorac. Surg., August 1, 1999; 68(2): 391 - 397. [Abstract] [Full Text] [PDF]
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 D. J. Miller, L. E. Samuels, M. S. Kaufman, R. J. Morris, M. P. Thomas, and S. K. Brockman Coronary Artery Bypass Surgery in Nonagenarians Angiology, August 1, 1999; 50(8): 613 - 617. [Abstract] [PDF]
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J. M. Murkin Strategies and Techniques for Neuroprotection in Coronary Artery Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1999; 3(1): 4 - 8. [Abstract] [PDF]
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C. W. Hogue JR, B. Barzilai, and V. G. Davila-Roman Stroke Reduction: Diagnosis and Management of the Atherosclerotic Ascending Aorta During Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1999; 3(1): 17 - 24. [Abstract] [PDF]
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M. F. Newman, D. T. Laskowitz, A. M. Saunders, A. M. Grigore, and H. P. Grocott Genetic Predictors of Perioperative Neurologic and Neuropsychological Injury and Recovery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1999; 3(1): 34 - 46. [Abstract] [PDF]
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R. L. Wolman, N. A. Nussmeier, A. Aggarwal, M. S. Kanchuger, G. W. Roach, M. F. Newman, C. M. Mangano, K. E. Marschall, C. Ley, D. M. Boisvert, et al. Cerebral Injury After Cardiac Surgery : Identification of a Group at Extraordinary Risk Stroke, March 1, 1999; 30(3): 514 - 522. [Abstract] [Full Text] [PDF]
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D. P.B. Janssen, L. Noyez, J. A.M. van Druten, S. H. Skotnicki, and L. K. Lacquet Predictors of neurological morbidity after coronary artery bypass surgery Eur. J. Cardiothorac. Surg., February 1, 1999; 15(2): 166 - 172. [Abstract] [Full Text] [PDF]
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S. Ashraf, K. Bhattacharya, S. Zacharias, P. Kaul, P. H. Kay, and K. G. Watterson Serum S100{beta} release after coronary artery bypass grafting: roller versus centrifugal pump Ann. Thorac. Surg., December 1, 1998; 66(6): 1958 - 1962. [Abstract] [Full Text] [PDF]
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C. M. Mangano Optimal Temperature Management During Cardiopulmonary Bypass: Warm, Cold, or Tepid? Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1998; 2(4): 283 - 293. [Abstract] [PDF]
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C. W. Akins Combined carotid endarterectomy and coronary revascularization operation Ann. Thorac. Surg., October 1, 1998; 66(4): 1483 - 1484. [Full Text] [PDF]
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M. B. Vroom Pharmacologic Management of Acute Heart Failure: A Review Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 1998; 2(3): 191 - 203. [Abstract] [PDF]
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R. C. King, R. C. Kanithanon, K. S. Shockey, W. D. Spotnitz, C. G. Tribble, and I. L. Kron Replacing the atherosclerotic ascending aorta is a high-risk procedure Ann. Thorac. Surg., August 1, 1998; 66(2): 396 - 401. [Abstract] [Full Text] [PDF]
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W. Plochl, D. J. Cook, T. A. Orszulak, and R. C. Daly Critical cerebral perfusion pressure during tepid heart operations in dogs Ann. Thorac. Surg., July 1, 1998; 66(1): 118 - 123. [Abstract] [Full Text] [PDF]
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G. D. Trachiotis and A. J. Pfister Management Strategy for Simultaneous Carotid Endarterectomy and Coronary Revascularization Ann. Thorac. Surg., October 1, 1997; 64(4): 1013 - 1018. [Abstract] [Full Text]
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E. J. Heyer, D. C. Adams, E. Delphin, D. J. McMahon, S. D. Steneck, M. C. Oz, R. E. Michler, and E. A. Rose CEREBRAL DYSFUNCTION AFTER CORONARY ARTERY BYPASS GRAFTING DONE WITH MILD OR MODERATE HYPOTHERMIA J. Thorac. Cardiovasc. Surg., August 1, 1997; 114(2): 270 - 277. [Abstract] [Full Text]
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T. J. Takach, G. J. Reul Jr, D. A. Cooley, J. M. Duncan, D. A. Ott, J. J. Livesay, G. L. Hallman, and O. H. Frazier Is an Integrated Approach Warranted for Concomitant Carotid and Coronary Artery Disease? Ann. Thorac. Surg., July 1, 1997; 64(1): 16 - 22. [Abstract] [Full Text]
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G. W. Roach, M. Kanchuger, C. M. Mangano, M. Newman, N. Nussmeier, R. Wolman, A. Aggarwal, K. Marschall, S. H. Graham, C. Ley, et al. Adverse Cerebral Outcomes after Coronary Bypass Surgery N. Engl. J. Med., December 19, 1996; 335(25): 1857 - 1864. [Abstract] [Full Text] [PDF]
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R. S. D'Agostino, L. G. Svensson, D. J. Neumann, H. H. Balkhy, W. A. Williamson, and D. M. Shahian Screening Carotid Ultrasonography and Risk Factors for Stroke in Coronary Artery Surgery Patients Ann. Thorac. Surg., December 1, 1996; 62(6): 1714 - 1723. [Abstract] [Full Text]
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L. L. Mickleborough, P. M. Walker, Y. Takagi, M. Ohashi, J. Ivanov, and M. Tamariz RISK FACTORS FOR STROKE IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1250 - 1259. [Abstract] [Full Text]
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C. T. Mora, M. B. Henson, W. S. Weintraub, J. M. Murkin, T. D. Martin, J. M. Craver, J. P. Gott, and R. A. Guyton THE EFFECT OF TEMPERATURE MANAGEMENT DURING CARDIOPULMONARY BYPASS ON NEUROLOGIC AND NEUROPSYCHOLOGIC OUTCOMES IN PATIENTS UNDERGOING CORONARY REVASCULARIZATION J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 514 - 522. [Abstract] [Full Text]
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J. M. Redmond, P. S. Greene, M. A. Goldsborough, D. E. Cameron, R. S. Stuart, M. S. Sussman, L. Watkins Jr, J. C. Laschinger, G. M. McKhann, M. V. Johnston, et al. Neurologic Injury in Cardiac Surgical Patients With a History of Stroke Ann. Thorac. Surg., January 1, 1996; 61(1): 42 - 47. [Abstract] [Full Text]
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M. Kitamura, M. Endo, F. Yamaki, G. Ohtsuka, H. Nishida, and H. Koyanagi Long-Term Results of Coronary Artery Bypass Grafting in Elderly Japanese Patients Ann. Thorac. Surg., September 1, 1995; 60(3): 576 - 579. [Abstract] [Full Text]
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C. W. Akins, A. C. Moncure, W. M. Daggett, R. P. Cambria, A. D. Hilgenberg, D. F. Torchiana, and G. J. Vlahakes Safety and Efficacy of Concomitant Carotid and Coronary Artery Operations Ann. Thorac. Surg., August 1, 1995; 60(2): 311 - 317. [Abstract] [Full Text]
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J. M. Murkin, J. S. Martzke, A. M. Buchan, C. Bentley, and C. J. Wong A RANDOMIZED STUDY OF THE INFLUENCE OF PERFUSION TECHNIQUE AND pH MANAGEMENT STRATEGY IN 316 PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY:II. Neurologic and cognitive outcomes J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 349 - 362. [Abstract] [Full Text]
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C. W. Hogue Jr., G. D. Lappas, L. L. Creswell, T. B. Ferguson Jr., M. Sample, D. Pugh, D. Balfe, J. L. Cox, and D. G. Lappas SWALLOWING DYSFUNCTION AFTER CARDIAC OPERATIONS: Associated adverse outcomes and risk factors including intraoperative transesophageal echocardiography J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 517 - 522. [Abstract] [Full Text]
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S. A. Mills Risk Factors for Cerebral Injury and Cardiac Surgery Ann. Thorac. Surg., May 1, 1995; 59(5): 1296 - 1299. [Abstract] [Full Text]
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