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J Thorac Cardiovasc Surg 2006;131:853-861
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Magnesium as a neuroprotectant in cardiac surgery: A randomized clinical trial

^a Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
^b Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio
^c Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
^d Pharmacy Department, Cleveland Clinic, Cleveland, Ohio

Received for publication April 4, 2005; revisions received October 20, 2005; accepted for publication November 21, 2005.

^_* Address for reprints: Eugene H. Blackstone, MD, Section of Clinical Research, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave/JJ40, Cleveland, OH 44195 (Email: blackse{at}ccf.org).

OBJECTIVE: We sought to evaluate magnesium as a neuroprotectant in patients undergoing cardiac surgery with cardiopulmonary bypass.

METHODS: From February 2002 to September 2003, 350 patients undergoing elective coronary artery bypass grafting, valve surgery, or both were enrolled in a randomized, blinded, placebo-controlled trial to receive either magnesium sulfate to increase plasma levels 1 to 2 times normal during cardiopulmonary bypass (n = 174) or no intervention (n = 176). Neurologic function, neuropsychologic function, and depression were assessed preoperatively, at 24 and 96 hours after extubation (neurologic) and at 3 months (neuropsychologic, depression). Neurologic scores were analyzed using ordinal longitudinal methods, and neuropsychologic and depression inventory data were summarized by principal component analysis, followed by linear regression analysis using component scores as response variables.

RESULTS: Seven (2%) patients had a postoperative stroke, 2 (1%) in the magnesium and 5 (3%) in the placebo group (P = .4). Neurologic score was worse postoperatively in both groups (P < .0001); however, magnesium group patients performed better than placebo group patients (P = .0001), who had prolonged declines in short-term memory and reemergence of primitive reflexes. Three-month neuropsychologic performance and depression inventory score were generally better than preoperatively, with few differences between groups (P > .6); however, older age (P = .0006), previous stroke (P = .003), and lower education level (P = .0007) were associated with worse performance.

CONCLUSIONS: Magnesium administration is safe and improves short-term postoperative neurologic function after cardiac surgery, particularly in preserving short-term memory and cortical control over brainstem functions. However, by 3 months, other factors and not administration of magnesium influence neuropsychologic and depression inventory performance.