Book Review

Cardiac Surgery and the Brain

N Engl J Med 1994; 331:209July 21, 1994

Article

Cardiac Surgery and the Brain
Edited by Peter L. Smith and K.M. Taylor. 284 pp., illustrated. London, Edward Arnold, 1993. $110. ISBN: 0-340-55315-4 (Distributed in the U.S. by Little, Brown, Boston.).

Postoperative neurologic and psychological disturbances have been a prominent cause of morbidity in patients undergoing heart surgery since the earliest use of cardiopulmonary bypass in 1955. This collection of 22 clinical essays elucidates the nature and extent of the problem, the techniques of assessment and diagnosis, and possible ways to reduce the risk of neurologic morbidity after open-heart surgery.

The topics and essayists have been chosen to avoid duplication, and editorial uniformity is well maintained. Most authors are from Germany and the United Kingdom, a fact that perhaps reflects greater recent investigational activity in those countries.

Essays in the section entitled “The Extent of the Problem” include descriptions of neurologic, psychological, and behavioral abnormalities assessed by a number of methods at intervals after various types of open-heart surgery in adults and children. The problems of embolization, profound hypothermia with low cerebral blood flow or none, and stress are well described, as is the difficulty of assigning exact causes to postoperative functional abnormalities in many patients.

The section on investigative techniques does not cover the postoperative evaluation of intellectual skills. The essays on blood flow and microembolism are well done. The seven essays in the section pertaining to therapeutic interventions are directed predominantly toward physiologic and biochemical management, rather than to alterations in surgical technique. It is disappointing that there is no discussion of alternative techniques of cerebral perfusion, including retrograde perfusion. Although the value of epicardial ultrasonography has not been proved, some discussion of this technique for avoiding the embolization of aortic debris would have been useful.

Overall, this book will be very useful to cardiovascular surgeons and cardiologists, as well as to students and technicians who would like a summary of the current understanding of neurologic complications of open-heart surgery in adults and children.

John J. Collins, Jr., M.D.
Brigham and Women's Hospital, Boston, MA 02115