Cognitive and neurobehavioral dysfunction after cardiac bypass procedures

The etiology of early neurocognitive deficits after coronary artery bypass grafting (CABG) surgery appears to be multifactorial. Late cognitive decline between 1 and 5 years after surgery has been demonstrated, but it remains unclear whether this late decline is specifically related to the use of cardiopulmonary bypass or to progression of underlying cerebrovascular disease during the follow-up period. Several studies have compared cognitive outcomes after cardiac surgery with or without the use of cardiopulmonary bypass, but to date there is no conclusive evidence that off-pump surgery is associated with a significant reduction in adverse neurocognitive outcomes. From a cognitive standpoint, contemporary CABG appears safe for most patients, but transient cognitive changes may still occur in a subset of patients, particularly those who have pre-existing cerebrovascular disease.