NEUROLOGIC FINDINGS IN CORONARY-ARTERY BYPASS PATIENTS - PERIOPERATIVE OR PREEXISTING

Objectives/Design: This prospective study compares the incidence of pr eexisting neurologic findings in elective cardiac surgery patients pre senting with and without coronary atherosclerosis. Setting:This single -center study was conducted at a tertiary care hospital, Participants/ lnterventions: After Review Board approval and obtaining written infor med consent, 11 patients undergoing valvular heart surgery, 9 patients undergoing similar valvular procedures with concomitant coronary arte ry bypass surgery, and 4 patients undergoing coronary artery bypass su rgery alone were enrolled. Preoperatively, all patients underwent a st ructured neurologic assessment, and the latter four additionally had p reoperative magnetic resonance imaging. Measurements and Main Results: The patients, 9 of 24 of whom were female, were aged 46 to 78 years a nd, other than ischemic heart disease, had medical histories that were similar between groups, with the exception of one patient having scle roderma, None of the patients had a clinical history of neurologic or cerebrovascular disease. Nine percent (1 of 11) of the valve-only pati ents showed subtle preoperative neurologic abnormalities, compared wit h 89% (eight of nine) of the valve patients having concomitant coronar y surgery and 100% (four of four) of coronary artery bypass-only patie nts. Additionally, brain imaging scans of all four coronary bypass pat ients showed nonspecific changes reported as scattered punctate areas of high signal less than 3 to 4 mm in diameter. Conclusion: This surve y shows that both subtle neurological abnormalities and magnetic reson ance imaging lesions can be found in a high percentage of patients wit h coronary atherosclerosis. Furthermore, this study indicates that wit hout a standardized preoperative neurological examination, postoperati ve neurologic dysfunction cannot necessarily be ascribed to perioperat ive events. Copyright (C) 1997 by W.B. Saunders Company.