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J Thorac Cardiovasc Surg 2005;130:1691-1697
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Preoperative cerebral ischemic lesions predict physical health status after on-pump coronary artery bypass surgery

^a University of Oslo, Faculty Division Rikshospitalet/The Interventional Centre,
^b Department of Thoracic and Cardiovascular Surgery,
^c Department of Surgery,
^d Interventional Centre,
^e Department of Radiology,
^f Department of Neurology, The University Hospital Rikshospitalet-Radiumhospitalet Trust, Oslo, Norway
^g Oslo University College of Nursing, Oslo, Norway
^h Institute of Public Health/Faculty of Social Sciences, University of Bergen, Norway

^_* Address for reprints: Lars Mathisen, RN, MS, University of Oslo, Faculty Division Rikshospitalet, The Interventional Centre, or the Department of Thoracic and Cardiovascular Surgery, The University Hospital Rikshospitalet-Radiumhospitalet Trust, Sognsvannsveien 20, 0027 Oslo, Norway (Email: lars.mathisen{at}medisin.uio.no).

BACKGROUND: Risk assessment is integral to patient selection and counseling before coronary artery revascularization. We studied the predictive ability of cerebral magnetic resonance imaging of preoperative and postoperative cerebral ischemic injury on self-reported physical and mental health at 3 months after coronary artery bypass surgery with or without use of cardiopulmonary bypass.

METHODS: In a prospective clinical trial comparing on-pump and off-pump surgery, 120 patients responded to a questionnaire for self-report of angina (Canadian Cardiovascular Society scale) and physical and mental health status (Short Form 36) at baseline before preoperative cerebral magnetic resonance imaging. Preoperative sets of both magnetic resonance imaging and self-assessments were available for 103 (85.8%) patients. These patients were grouped according to classification of preoperative cerebral magnetic resonance imaging findings. Analysis of covariance determined the association of (1) preoperative magnetic resonance imaging status, (2) new postoperative cerebral lesions, and (3) actual use of cardiopulmonary bypass to physical and mental health.

RESULTS: At 3 months after surgical intervention, 98 of 103 patients completed follow-up. The analysis revealed an interaction effect of preoperative cerebral ischemic injury and use of cardiopulmonary bypass on physical health (F = 9.07, P = .003) independent of age. No independent effects on health status were found of baseline magnetic resonance imaging or new cerebral lesions at 3 months.

CONCLUSIONS: This study strongly suggests that the combination of preoperative cerebral ischemic injury and use of cardiopulmonary bypass can predict postoperative health status at 3 months. Cerebral magnetic resonance imaging might be a more specific indicator than age for preoperative assessment of vulnerability or resilience during rehabilitation after on-pump cardiac surgery.

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