Commentary: Power-washing the brain with the heart-lung machine?

Abstract

In this issue of the Journal, Browne and colleagues 1 report the incidence and describe the importance of covert stroke during coronary artery bypass surgery (CABG) in 49 patients who had diffusion-weighed magnetic resonance imaging (DW-MRI) of the brain, showing 39% with perioperative covert stroke, 6% with clinical stroke, 26% with delirium, and 10% with no stroke. These are important findings for such a routine procedure. Here we provide some insight into this problem. Brain Injury After Cardiac SurgeryBrain injury is a major complication of cardiac surgery and significantly increases the likelihood of the need for long-term care. Perioperative stroke occurs in 2%-6% of all patients. More than 20% of patients aged >65 years and 33% of those aged>80 years experience postoperative delirium. The rate of postoperative cognitive dysfunction is estimated to exceed 80% at discharge, and the dysfunction persists in 25% of patients at 1 year. Brain injury also may trigger chronic or progressive dementia. [2][3][4]