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Perfusion, Vol. 22, No. 1, 27-33 (2007)
DOI: 10.1177/0267659107077952

Investigation of factors relating to neuropsychological change following cardiac surgery

Paul D Raymond

Research Concentration in Biological and Medical Sciences, School of Life Sciences, Queensland University of Technology, Brisbane, Australia, Department of Perfusion Services, The Prince Charles Hospital, Brisbane, Australia, p.raymond@ optusnet.com.au

Michael Radel

Department of Psychology and Neuropsychology, The Prince Charles Hospital, Brisbane, Australia

Michael J Ray

Department of Haematology, The Prince Charles Hospital, Brisbane, Australia

Anton D Hinton-Bayre

Discipline of General Practice, School of Medicine, University of Queensland, Brisbane, Australia

Neville A Marsh

Research Concentration in Biological and Medical Sciences, School of Life Sciences, Queensland University of Technology, Brisbane, Australia

Background. An analysis of neuropsychological impairment following cardiopulmonary bypass was performed in 55 patients undergoing elective coronary artery bypass grafting. Methods. Neurocognitive function was measured preoperatively using the MicroCog: Assessment of Cognitive Functioning computer-based testing tool. Testing was repeated in the postoperative period immediately prior to discharge from hospital. Analysis of significant score decline was performed using the standardised regression-based technique. A patient was classified as overall impaired when ≥20% of test scores were significantly impaired. The proposed marker of neurological damage S-100ß was also used. Prothrombin Fragment 1+2 (F1+2) was measured as a marker of thrombin development to test the hypothesis that excessive haemostatic activation may lead to thromboembolic damage to the brain. Results and Conclusions. 32.7% of patients were classified as significantly impaired. No relationship was detected between F1+2 and any neuropsychological test score; however, the study was limited due to small sample size. F1+2 levels were higher in patients undergoing prolonged bypass times. Neuropsychological decline was significantly correlated with patient age, suggesting a degree of caution is warranted when operating on an elderly cohort. An unexpected relationship was detected between higher heparin concentrations and increased risk of neuropsychological impairment; however, this requires re-evaluation. Perfusion (2007) 22, 27—33.

Key Words: Cardiopulmonary bypass • neurocognitive deficits • cerebral complications • coagulation • heparin


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