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J Thorac Cardiovasc Surg 2003;125:S28-S30
© 2003 The American Association for Thoracic Surgery

Editorials

Neurologic injury from cardiac surgery—an important but enormously complex phenomenon

From the Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.

Received for publication July 18, 2000. Accepted for publication July 19, 2000. Address for reprints: Eugene H. Blackstone, MD, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195 (E-mail: blackse@ccf.org).

The first 20% of the full text of this article appears below.

	Simplism

 
Simplism (noun): The tendency to oversimplify an issue or a problem by ignoring complexities or complications. ¹

In this issue of the Journal, van Dijk and his colleagues ² ask a simple question: What proportion of patients have persistent cognitive dysfunction after coronary artery bypass grafting with cardiopulmonary bypass? Their pursuit of a single-number simple answer began as a meta-analysis of the literature. However, they abandoned formal meta-analysis when they deemed that compatibility of studies was insufficient. Instead, they found an answer as a simple, weighted average from a handful of systematically reviewed papers.

Simple question, simple answer? Or simplistic question and simplistic answer?

	De ja vu

 
As mortality and morbidity associated with cardiac injury and dysfunction have retreated in recent years, acute and persistent central nervous system injury and dysfunction after cardiac surgery have emerged as a dominating issue. However, the questions being asked about neurologic events from cardiac surgery parallel those of a generation ago, when possible injury to the heart was center stage. What is the definition of irreversible injury? Can the injury be quantified? How can irreversible or irreparable injury be distinguished from reversible phenomena? Are there blood-borne, accessible biologic markers of the injury that are reliable, specific, sensitive, and quantitative? What are the etiologies of the injury and can they be either avoided or neutralized? Are functional changes reflective of morphologic injury? What aspects of dysfunction are related to true injury and what fraction to a myriad of other aggravating factors that may be neutralized?

Neurologic injury and cognitive and behavioral dysfunction after cardiac surgery are at least as complex phenomena as myocardial injury and functional stunning. The centrality of the . . . [Full Text of this Article]

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