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J Thorac Cardiovasc Surg 2006;131:1358-1363
© 2006 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Relationship between white cell count, neuropsychologic outcome, and microemboli in 161 patients undergoing coronary artery bypass surgery

University College London and University College London Hospitals, London, United Kingdom.

Received for publication September 2, 2005; revisions received October 31, 2005; accepted for publication January 3, 2006.

^_* Address for reprints: Stanton Newman, DPhil, Unit of Health Psychology, Centre for Behavioural and Social Sciences in Medicine, University College London, 2nd Floor, Wolfson Building, 48 Riding House St, London W1W 7EY. (Email: s.newman{at}ucl.ac.uk).

OBJECTIVE: Neuropsychologic impairment remains a problem after coronary artery bypass grafting. Relatively few studies have examined the potential role of the perioperative inflammatory response. This study aimed to determine whether there was any association between perioperative white cell count, microemboli, and cognitive performance after surgical intervention.

METHODS: White cell count and differential were prospectively measured perioperatively in 161 patients undergoing coronary artery bypass grafting. A neuropsychologic test battery (9 tests) was administered preoperatively and 6 to 8 weeks postoperatively in all 161 patients. Cerebral microemboli during cardiopulmonary bypass were also recorded by means of a transcranial Doppler scan of the right middle cerebral artery.

RESULTS: There was no correlation between microemboli and white cell counts at any time point. There were weak but significant inverse correlations between both preoperative (r = –0.19, P = .02) and postoperative (r = –0.21, P < .01) white cell count and a measure of overall neuropsychologic test performance (total z change score). There was a weak but significant positive correlation between the neutrophil count 10 minutes after bypass and the intraoperative microemboli count (r = 0.23, P = .01).

CONCLUSIONS: The correlation between white cell count and neuropsychologic outcome suggests that an inflammatory response might have a role in determining cognitive outcome after coronary artery surgery with cardiopulmonary bypass. The positive correlation between the microemboli during cardiopulmonary bypass and the neutrophil count 10 minutes after bypass is compatible with microemboli contributing to the inflammatory response. The patients' preoperative inflammatory status might also be predictive of the response to surgical intervention.

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