Original Article
Adverse Cerebral Outcomes after Coronary Bypass Surgery
N Engl J Med 1996; 335:1857-1864December 19, 1996
- Abstract
Background
Acute changes in cerebral function after elective coronary bypass surgery are a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of — and the use of resources associated with — perioperative adverse neurologic events, including cerebral injury.
Methods
In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures).
Results
Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of 3.1 percent had type I neurologic outcomes (8 died of cerebral injury, 55 had nonfatal strokes, 2 had transient ischemic attacks, and 1 had stupor), and 3.0 percent had type II outcomes (55 had deterioration of intellectual function and 8 had seizures). Patients with adverse cerebral outcomes had higher in-hospital mortality (21 percent of patients with type I outcomes died, vs. 10 percent of those with type II and 2 percent of those with no adverse cerebral outcome; P<0.001 for all comparisons), longer hospitalization (25 days with type I outcomes, 21 days with type II, and 10 days with no adverse outcome; P<0.001), and a higher rate of discharge to facilities for intermediate- or long-term care (47 percent, 30 percent, and 8 percent; P<0.001). Predictors of type I outcomes were proximal aortic atherosclerosis, a history of neurologic disease, and older age; predictors of type II outcomes were older age, systolic hypertension on admission, pulmonary disease, and excessive consumption of alcohol.
Conclusions
Adverse cerebral outcomes after coronary bypass surgery are relatively common and serious; they are associated with substantial increases in mortality, length of hospitalization, and use of intermediate- or long-term care facilities. New diagnostic and therapeutic strategies must be developed to lessen such injury.
Media in This Article
Figure 1
Incidence of Type I and Type II Cerebral Outcomes According to Age.Table 1
Selected Demographic, Medical, and Operative Characteristics of The Study Patients.Article Activity
- Article
Stroke, the third leading cause of death in the United States, will continue to be a challenging problem as the population ages. Patients who undergo myocardial revascularization procedures, now more than 800,000 a year throughout the world, are particularly prone to stroke, encephalopathy, and other neurologic dysfunction, because they are relatively old and have atherosclerotic disease. They are also subject to marked hemodynamic fluctuations; cerebral embolization of atherosclerotic plaque, air, fat, and platelet aggregates; cerebral hyperthermia after the discontinuation of cardiopulmonary bypass; and other inflammatory and neurohumoral derangements associated with surgery.1-5
Although cerebral complications are responsible for an increasing proportion of perioperative deaths,6,7 their incidence and effects have not been rigorously investigated. The majority of studies have been performed only at one center, have enrolled a limited number of patients, or have been retrospective (all of which has resulted in substantial variability among findings). Among the studies, for example, there is a more than 10-fold variation in the reported incidence of perioperative stroke (from 0.4 to 5.4 percent) and a 3-fold variation (25 to 79 percent) in that of in-hospital neuropsychological dysfunction.3,4,8,9 Studies of perioperative stroke have not attempted to identify potentially reversible risk factors, nor have they examined the long-term impact of perioperative cerebral outcomes on the use of resources.3,7,10
Our investigation was designed as a multi-institutional, prospective, observational study to determine the incidence of both stroke and encephalopathy after coronary-artery bypass graft (CABG) surgery, to identify the independent predictors of these cerebral outcomes, and to define their impact on the use of resources, as measured by the lengths of hospital stays and the need for intensive intermediate- or long-term care.
Methods
The cardiac surgery study of the Multicenter Study of Perioperative Ischemia was a prospective observational study that enrolled 2417 patients who underwent elective CABG surgery in 24 U.S. medical institutions between September 1991 and September 1993. The goals of the study were to define the incidence of adverse perioperative outcomes, to measure the prevalence of selected characteristics of the patients, and to assess the use of resources. At each of the centers, between 100 and 108 patients were prospectively enrolled according to a systematic sampling scheme, and perioperative demographic, clinical, and laboratory data were collected on the patients from hospital entry to discharge. Data on all patients with new perioperative neurologic findings were independently reviewed by six investigators, who examined additional data (computed-tomography findings, autopsy reports, and hospital-discharge summaries) if necessary. Final classification of outcome was made by consensus of this panel in two categories: type I was defined as death due to stroke or hypoxic encephalopathy, nonfatal stroke, transient ischemic attack (TIA), or stupor or coma at the time of discharge; and type II was defined as a new deterioration in intellectual function, confusion, agitation, disorientation, memory deficit, or seizure without evidence of focal injury. Because the two types of neurologic outcome were assumed to have different causes and predictors, and because the predictors for type I outcome could potentially mask those for type II, patients with more than one type of neurologic outcome were classified, for analytic purposes, hierarchically, according to the severity of outcome. Type I outcomes were considered more severe than type II. Within type I, the diagnoses were ranked from most to least severe: fatal injury, stroke, stupor or coma, and TIA. The type II diagnoses were ranked in a similar fashion.
Patients excluded from the analysis (n = 309) could not be evaluated for neurologic outcome (6 patients), had undergone concomitant intracardiac or vascular procedures (299 patients), or had died during surgery (4 patients) (none died of cerebral causes). Variables considered potential predictors of neurologic outcome were categorized according to operative stage as preoperative (e.g., age, sex, a history of congestive heart failure or of CABG), intraoperative (e.g., the duration of cardiopulmonary bypass and aortic cross-clamping, surgical and anesthetic technique, hemodynamic changes, the use of transfusions), and postoperative (e.g., myocardial infarction, dysrhythmia, ventricular dysfunction). The use of resources was assessed on the basis of (1) the length of stay in the intensive care unit and the total postsurgical stay in the hospital, and (2) the site to which the patient was discharged (his or her home or an intermediate- or long-term care facility).
Statistical Analysis
The univariable associations between adverse neurologic outcome (type I or type II) and potential predictors were assessed with either Fisher's exact test or the Kruskal–Wallis test, as appropriate. Stepwise logistic regression was then performed separately for type I and type II outcomes, including predictors associated with P values no greater than 0.20 in univariable analyses and keeping predictors with P values no greater than 0.15 in the multivariable model. All models were sorted with Akaike's information criterion (AIC)11; goodness of fit for each model was determined with the Hosmer–Lemeshow test.12 The model with the lowest AIC was considered to have the best fit.
The data in this study produced several models with similar low AIC values. Our final model was chosen on the basis of clinical relevance, and not all variables reached a P value of 0.05 or less. Results are reported as odds ratios with associated 95 percent confidence intervals.
Results
Demographic and operative characteristics of the 2108 patients in this study are presented in Table 1Table 1
Selected Demographic, Medical, and Operative Characteristics of The Study Patients.. Patients were relatively old (32 percent were 70 years of age or more) and had a history of hypertension, unstable angina, heart failure, or diabetes; approximately 8 percent had a history of stroke or transient ischemic attack. A total of 6.1 percent of the patients (129) had perioperative adverse cerebral outcomes. Type I outcomes occurred in 3.1 percent (66), including 8 deaths due to cerebral injury, 55 nonfatal strokes, 2 TIAs, and 1 case of stupor at the time of discharge. Type II outcomes occurred in 3.0 percent (63), including 55 with deterioration in intellectual function and 8 with seizures. The outcome rates, according to institution, ranged from 1 percent to 13.8 percent (range for type I outcomes alone, 0 to 8.6 percent; for type II, 0 to 9.3 percent).Predictors of Type I and Type II Outcomes
On the basis of our univariable analysis (Table 1), logistic regression identified eight independent predictors of type I cerebral outcomes (Table 2Table 2
Adjusted Odds Ratios for Type I and Type II Cerebral Outcomes Associated with Selected Risk Factors.). Proximal aortic atherosclerosis, as identified by the cardiac surgeon, was the strongest independent predictor, associated with a more than fourfold increase in risk. It was followed by a history of neurologic disease, an age of 70 or more (Figure 1Figure 1Incidence of Type I and Type II Cerebral Outcomes According to Age.), and a history of pulmonary disease. Both perioperative hypotension and the use of a ventricular venting procedure during surgery, although their point estimates were not statistically significant, were included in the final model since they did not detract from the statistical fit of the model and they have clinical relevance. Adjustment for the study site did not affect the results of the multivariable model. Ten independent predictors of type II cerebral outcome were identified, of which seven were statistically significant (P<0.05) (Table 2). Predictors unique to type II were a history of excessive alcohol consumption, prior CABG surgery, dysrhythmia, a history of peripheral vascular disease, and congestive heart failure on the day of surgery (although the last two were not statistically significant). Predictors common to both type I and type II outcomes were older age, a history of pulmonary disease, a history of hypertension or existing hypertension, and perioperative hypotension.Postoperative Course
Type I outcomes were associated with an approximately 10-fold increase in in-hospital mortality, and type II with an approximately 5-fold increase (Table 3Table 3
Mortality and Postoperative Resource Use, According to Cerebral Outcome.). Similarly, the average length of the postsurgical hospital stay and the amount of time spent in intensive care were at least doubled in the patients with adverse cerebral outcomes. Of the patients with type I outcomes, 47 percent were discharged to skilled-nursing facilities or rehabilitation centers, as compared with 30 percent of patients with type II outcomes and 8 percent of patients without adverse cerebral outcomes.Discussion
This study was a large multicenter, prospective investigation of adverse cerebral outcomes after elective CABG surgery. Serious adverse cerebral outcomes occurred in 6.1 percent of patients, evenly divided between type I outcomes (fatal cerebral injury and nonfatal strokes) and type II (new deterioration in intellectual function or new onset of seizures). Adverse cerebral outcomes were associated with significantly increased mortality and use of medical resources. There was a 5-to-10-fold increase in mortality associated with type I and type II outcomes; furthermore, the 21 percent mortality rate found with perioperative stroke is similar to the rate reported from a single center more than a decade ago and suggests that stroke-related mortality has not decreased over the past decade.6 The duration of intensive care and of the total hospital stay was prolonged by both type I and type II outcomes — a finding not previously reported with type II outcomes. High-risk characteristics were identified; they included, among others, advanced age, proximal aortic atherosclerosis, neurologic disease, pulmonary disease, and a history of or existing hypertension. These results emphasize the medical importance of adverse cerebral outcomes after CABG surgery; they have economic implications as well.1,3,13
We examined conservative measures of resource use — namely, the duration of intensive care, the total duration of the hospital stay after surgery, and the rate of discharge to intermediate- or long-term care facilities. All three measures were markedly prolonged for patients with either type I or type II adverse neurologic outcomes. As compared with patients without adverse cerebral outcomes, patients with stroke stayed an additional eight days in the intensive care unit and an additional seven days on the ward, suggesting that regardless of institutional practice, substantial resources are consumed by such patients. This confirms previous findings from single-center studies.2,4,10,14 Again as compared with patients without adverse cerebral outcomes, patients with type II outcomes stayed an additional four days in the intensive care unit and seven days on the ward. On the basis of conservative estimates of boarding charges of $890 per day in an intensive care unit and $370 per day on a ward,1,14 type I neurologic events are responsible for an additional $10,266 per patient in in-hospital boarding costs, and type II events for an additional $6,150 per patient.1-3,10,14 If we apply these estimates to the 800,000 patients per year who undergo CABG surgery throughout the world, the additional in-hospital cost is approximately $400 million annually.1 True in-hospital costs, including charges for personnel and in-hospital services, if added to the expense of an array of long-term out-of-hospital medical and rehabilitative services, probably result in an additional expenditure ranging from 5 to 10 times the narrowly defined in-hospital costs, or some $2 billion to $4 billion annually.1 As an example of the increased cost, consider that 90 percent of patients without adverse cerebral outcomes were discharged to their homes, as compared with only 32 percent of patients with type I outcomes and 60 percent with type II outcomes. Whether the need for prolonged hospitalization and the changes in discharge patterns are caused directly by the neurologic complications or by other associated illness is uncertain, yet it is likely that adverse cerebral outcomes affect the use of health care resources profoundly.
Predictors Unique to Type I Outcomes
Moderate-to-severe proximal aortic atherosclerosis, as identified by intraoperative palpation of the aorta, was associated with an incidence of type I adverse cerebral outcomes at least four times that among patients without the condition. This finding supports the theory that most strokes are caused by large atherosclerotic emboli liberated by surgical manipulation of the aorta.3,15-22 In our study, proximal aortic atherosclerosis, detected by palpation, was found in approximately 12 percent of all patients and in 20 percent of patients >70 years of age. Moderate or severe atherosclerotic disease has been detected with ultrasonographic scanning in 14 to 20 percent of elderly patients.3,23-27 Although palpation of the aorta is not as sensitive a measure as other techniques, such as echocardiography, the method is simple and can be used routinely to identify patients at risk and therefore to indicate alterations in surgical technique. Such alterations might include the adjustment of the site for aortic clamping and cannulation, to avoid atherosclerotic regions; the use of arterial conduits (e.g., internal thoracic or epigastric arteries) to avoid aortic anastomoses; the use of hypothermic fibrillatory arrest without clamping the aorta; or the use of hypothermic circulatory arrest, with replacement of the diseased aorta.1,3,4,24,27-30
A history of neurologic abnormality — for example, stroke or TIA — was also a significant risk factor for type I outcomes, a finding consistent with those of other studies.7,31 A history of neurologic disease suggests existing pathologic cerebrovascular conditions, such as impaired cerebral blood flow and autoregulation or inadequate collateral vessels, which may predispose patients to a type I cerebral complication after CABG surgery. Patients with diabetes mellitus also had an increased risk of a type I outcome, perhaps reflecting these patients' impaired autoregulation during bypass3,4,15,32 or more generalized atherosclerosis, involving the aorta or the carotid or cerebral arteries. Unstable angina has been associated with a prothrombotic state and systemic immunologic-cascade activation that may contribute to the development of neurologic injury.33 The use of a left ventricular venting procedure was weakly associated with the occurrence of a type I adverse neurologic outcome, but the relatively small number of patients without vents limited statistical assessment. The placement of a vent may introduce air into the left side of the heart that subsequently embolizes and travels to the brain3,4,19,34 — a danger that highlights the importance of fastidious surgical technique if a vent is used. A final factor, the use of an intraaortic balloon pump, may be associated with the dislodgment of aortic emboli or may be a marker of hypoperfusion.
Predictors Unique to Type II Outcomes
Proximal aortic atherosclerosis was not an independent predictor of type II cerebral outcomes, suggesting that large atherosclerotic emboli do not have a primary role in the pathophysiology of encephalopathy or seizures after bypass surgery. This is consistent with previous studies demonstrating an association between small emboli, or inadequate cerebral flow, and type II outcomes.1,3,4,35,36 Risk factors unique to type II outcomes were a history of excessive alcohol consumption; postoperative dysrhythmia (mainly, atrial fibrillation), which may induce cerebral emboli or hypoperfusion14; and a history of CABG or peripheral vascular disease, which may reflect more advanced atherosclerosis.
Predictors of Both Type I and Type II Outcomes
Advanced age, particularly an age of 70 or more, was a leading factor associated with both type I and type II adverse cerebral outcomes. Aging is associated with atherosclerosis and an increased risk of embolic phenomena, as well as with alterations in cerebral vasculature3,4,6,7,15,17,37-40 and the autoregulation of blood flow,8,41-43 all of which may increase the incidence of perioperative stroke, cognitive dysfunction, and delirium.3,4,6,7,15,18,28,38-40,44,45 Pulmonary disease (emphysema, chronic bronchitis, restrictive lung disease, or asthma), a previously unreported risk factor for either type I or type II outcomes, was in our study a significant predictor of both; patients with pulmonary disease probably retained carbon dioxide (thus affecting cerebral vasoreactivity) or required prolonged mechanical ventilation (thus affecting the degree of cerebral perfusion and oxygenation).1,3,16,28,46 Both a history of hypertension and existing hypertension were associated with adverse cerebral outcomes — a reflection of impaired cerebrovascular autoregulation and more generalized atherosclerotic disease in hypertensive patients.
Strengths and Limitations of the Study
The reported incidence of perioperative stroke in studies from only one center varies by a factor of more than 10, from 0.4 to 5.4 percent,1-4,8,16,47 with similar variability in the rates of encephalopathy, delirium, and confusion. Most likely, this variability is due to differences in study design (for instance, whether the studies were retrospective or prospective), methods, sample size, and the effects of site-specific factors.1-3,9,48,49 Our study addressed these limitations by enrolling patients at multiple diverse institutions, thereby minimizing distortion due to the effects of surgical, anesthetic, perfusion-related, and medical practices specific to a single center; randomizing enrollment and limiting it to a period of 24 months in order to decrease the impact of temporal changes in practice; collecting data prospectively; and excluding procedures, such as valve replacement or aneurysmectomy, that might increase a patient's risk of adverse neurologic events.4,20,31
Our study, however, has several limitations of its own. First, the neurologic findings were assessed by investigators at each site, not by a single neurologist performing all preoperative and postoperative examinations; there may be significant variations in clinical practice, and thus diagnosis, among the 24 centers (although no site-related effect was identified). Second, neuropsychological deficits were not formally assessed because of several constraints, including a lack of technical experience in neuropsychological testing and the time required for such testing. Our assessment of deterioration in intellectual function is thus open to criticism. Third, our categorization of outcomes as type I or type II presumed differences in the characteristic mechanisms of injury in the two types — focal and diffuse, respectively35,36 (although this presumption is consistent with our finding that few of the predictors in the multivariable analysis of type I and type II outcomes were similar). Fourth, we detected aortic atherosclerosis by surgical palpation. Recent studies have shown that ultrasonography is superior to palpation in detecting aortic atheromas, but our study was designed and our data collected before the publication of those reports. Finally, several recent studies suggest an association between the presence of carotid-artery stenosis, as documented by carotid duplex scanning, and stroke after cardiac surgery.1,3,4,24,31 We found a strong univariable correlation between the presence of carotid disease (including carotid bruit, stenosis, or endarterectomy) and type I cerebral outcomes (P<0.001), but carotid duplex scanning was not performed as part of the study. Perhaps because of the relatively poor specificity and selectivity of carotid bruit as a sign of hemodynamically important lesions, we were unable to document an association between carotid disease and adverse cerebral outcome in the multivariable analysis.
On the basis of data from 24 U.S. medical centers, we conclude that adverse perioperative cerebral outcomes are both relatively common (they occur in 6.1 percent of patients) and serious. As compared with patients with no adverse outcomes, the patients with such outcomes had 5 to 10 times the mortality, 2 to 4 times the time spent in intensive care and in the hospital, and 3 to 6 times the need for prolonged care. We were able to identify patients at high risk both for focal and for diffuse injury, thereby allowing improved stratification of risk. Further investigation is necessary, however, to develop diagnostic and therapeutic strategies1,3,49 to reduce mortality and morbidity and to conserve resources.
Supported by grants from the Ischemia Research and Education Foundation.
Source Information
From Kaiser Permanente Medical Center, San Francisco (G.W.R.); New York University, N.Y. (M.K., K.M.); Stanford University, Stanford, Calif. (C.M.M.); Duke University, Durham, N.C. (M.N.); Mercy Medical Center, Redding, Calif. (N.N.); Medical College of Virginia, Richmond (R.W.); Veterans Affairs Medical Center, Milwaukee (A.A.); University of Pittsburgh, Pittsburgh (S.H.G.); the Ischemia Research and Education Foundation, San Francisco (C.L.); and the Veterans Affairs Medical Center, San Francisco (G.O., D.T.M.).
Address reprint requests to Dr. Dennis Mangano at the Ischemia Research and Education Foundation, 250 Executive Park Blvd., Suite 3400, San Francisco, CA 94134.
Participants in the study are listed in the Appendix.
Other authors were Ahvie Herskowitz, M.D., Vera Katseva, Ph.D., and Rita Sears, R.N., M.S.
Appendix
The following coordinated the study and the analyses: Study Director — D. Mangano; Coordinating Center, Ischemia Research and Education Foundation — C. Dietzel, V. Katseva, E. Kwan, A. Herskowitz, C. Ley, and L. Ngo; Outcome Validation Committee — S. Graham, C. Mora Mangano, N. Nussmeier, G. Ozanne, G. Roach, and R. Wolman; Editorial–Administrative Group — D. Beatty, M. Riddle, I. Asturias, B. Xavier, and W. von Ehrenburg.
The following institutions and investigators participated in the study: University of Alabama at Birmingham — W. Lell; Baylor College of Medicine — S. Shenaq and R. Clark; Cedars–Sinai Medical Center — A. Friedman; University of Chicago — M. Trankina and W. Ruo; Cleveland Clinic Foundation — C. Koch and N. Starr; Cornell University — O. Patafio and R. Fine; Duke University — T. Stanley and M. Newman; Emory University — C. Mora Mangano and J. Ramsay; Harvard University and Beth Israel Hospital — M. Comunale; Brigham and Women's Hospital — S. Body and R. Maddi; Massachusetts General Hospital — M. D'Ambra; University of Iowa — A. Ross; Kaiser Permanente Medical Center, San Francisco — G. Roach and W. Bellows; University of Michigan — J. Wahr; New York University — M. Kanchuger and K. Marschall; University of Pennsylvania — J. Savino; Rush–Presbyterian–St. Luke's Medical Center — K. Tuman; Stanford University — E. Stover and L. Siegel; Texas Heart Institute — S. Slogoff and M. Goldstein; Milwaukee Veterans Affairs Medical Center — A. Aggarwal; San Francisco Veterans Affairs Medical Center — G. Ozanne and D. Mangano; Medical College of Virginia — J. Fabian and R. Wolman; University of Washington — B. Spiess; Yale University — J. Mathew.
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A. E. van Harten, T. W. L. Scheeren, A. R. Absalom. (2012) A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia. Anaesthesia 67:3, 280-293
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Wojciech Dabrowski, Ziemowit Rzecki, Jacek Pilat, Marek Czajkowski. (2012) Brain damage in cardiac surgery patients. Current Opinion in Pharmacology
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S. Nozohoor, P. Johnsson, S. Scicluna, P. Wallentin, E. Andell, J. Nilsson. (2012) A case-controlled evaluation of the Medtronic Resting Heart System compared with conventional cardiopulmonary bypass in patients undergoing isolated coronary artery bypass surgery. Interactive CardioVascular and Thoracic Surgery
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Rizwan A. Manji, Hilary P. Grocott, Jill Leake, Rob E. Ariano, Jacqueline S. Manji, Alan H. Menkis, Eric Jacobsohn. (2011) Seizures following cardiac surgery: the impact of tranexamic acid and other risk factors. Canadian Journal of Anesthesia/Journal canadien d'anesthésie
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Irene Lecker, Beverley A. Orser, C. David Mazer. (2011) “Seizing” the opportunity to understand antifibrinolytic drugs. Canadian Journal of Anesthesia/Journal canadien d'anesthésie
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Nanette M. Schwann, Zak Hillel, Andreas Hoeft, Paul Barash, Patrick Möhnle, Yinghui Miao, Dennis T. Mangano. (2011) Lack of Effectiveness of the Pulmonary Artery Catheter in Cardiac Surgery. Anesthesia & Analgesia 113:5, 994-1002
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L. David Hillis, Peter K. Smith, Jeffrey L. Anderson, John A. Bittl, Charles R. Bridges, John G. Byrne, Joaquin E. Cigarroa, Verdi J. DiSesa, Loren F. Hiratzka, Adolph M. Hutter, Michael E. Jessen, Ellen C. Keeley, Stephen J. Lahey, Richard A. Lange, Martin J. London, Michael J. Mack, Manesh R. Patel, John D. Puskas, Joseph F. Sabik, Ola Selnes, David M. Shahian, Jeffrey C. Trost, Michael D. Winniford. (2011) 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. Journal of the American College of Cardiology
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Yuji Kadoi, Chikara Kawauchi, Masataka Kuroda, Kenichiro Takahashi, Shigeru Saito, Nao Fujita, Akio Mizutani. (2011) Association between cerebrovascular carbon dioxide reactivity and postoperative short-term and long-term cognitive dysfunction in patients with diabetes mellitus. Journal of Anesthesia 25:5, 641-647
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Judith A. Hudetz, Zafar Iqbal, Sweeta D. Gandhi, Kathleen M. Patterson, Alison J. Byrne, Paul S. Pagel. (2011) Postoperative Delirium and Short-term Cognitive Dysfunction Occur More Frequently in Patients Undergoing Valve Surgery With or Without Coronary Artery Bypass Graft Surgery Compared With Coronary Artery Bypass Graft Surgery Alone: Results of a Pilot Study. Journal of Cardiothoracic and Vascular Anesthesia 25:5, 811-816
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George J. Arnaoutakis, Timothy J. George, Kevin K. Wang, Mary Ann Wilson, Jeremiah G. Allen, Chase W. Robinson, Kara A. Haggerty, Eric S. Weiss, Mary E. Blue, Charles C. Talbot, Juan C. Troncoso, Michael V. Johnston, William A. Baumgartner. (2011) Serum levels of neuron-specific ubiquitin carboxyl-terminal esterase-L1 predict brain injury in a canine model of hypothermic circulatory arrest. The Journal of Thoracic and Cardiovascular Surgery 142:4, 902-910.e1
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Luisa Gregorini, Jean Marco, Gerd Heusch. (2011) Peri-interventional coronary vasomotion. Journal of Molecular and Cellular Cardiology
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A.R. Naylor, Z. Mehta, P.M. Rothwell, P.R.F. Bell. (2011) Reprinted Article “Carotid Artery Disease and Stroke During Coronary Artery Bypass: A Critical Review of the Literature”. European Journal of Vascular and Endovascular Surgery 42, S73-S83
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N. Terrando, M. Brzezinski, V. Degos, L. I. Eriksson, J. H. Kramer, J. M. Leung, B. L. Miller, W. W. Seeley, S. Vacas, M. W. Weiner, K. Yaffe, W. L. Young, Z. Xie, M. Maze. (2011) Perioperative Cognitive Decline in the Aging Population. Mayo Clinic Proceedings 86:9, 885-893
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Ali Mahajerin, Warren J. Manning. 2011. Prevention of Cardioembolic Stroke. , 179-203.
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Dayal Mukherjee, Christopher Rao, Michael Ibrahim, Kamran Ahmed, Hutan Ashrafian, Aristotle Protopapas, Ara Darzi, Thanos Athanasiou. (2011) Meta-Analysis of Organ Damage After Conversion From Off-Pump Coronary Artery Bypass Procedures. The Annals of Thoracic Surgery 92:2, 755-761
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Eugene A. Hessel. (2011) CNS Monitoring: The Current Weak State of the Evidence. Journal of Cardiothoracic and Vascular Anesthesia 25:4, e15-e16
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Andrew B. Goldstone, David J. Bronster, Joanna Chikwe. (2011) Seizures After Adult Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia 25:4, e25-e26
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Martin Misfeld, R. John L. Brereton, Elizabeth A. Sweetman, Gordon S. Doig. (2011) Neurologic complications after off-pump coronary artery bypass grafting with and without aortic manipulation: Meta-analysis of 11,398 cases from 8 studies. The Journal of Thoracic and Cardiovascular Surgery 142:2, e11-e17
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Solomon Aronson, Cornelius M. Dyke, Jerrold H. Levy, Albert T. Cheung, Philip D. Lumb, Edwin G. Avery, Ming-yi Hu, Mark F. Newman. (2011) Does Perioperative Systolic Blood Pressure Variability Predict Mortality After Cardiac Surgery? An Exploratory Analysis of the ECLIPSE trials. Anesthesia & Analgesia 113:1, 19-30
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Sotiris C. Stamou, Marcy Nussbaum, John D. Carew, Kelli Dunn, Eric Skipper, Francis Robicsek, Kevin W. Lobdell. (2011) Hypoglycemia with intensive insulin therapy after cardiac surgery: Predisposing factors and association with mortality. The Journal of Thoracic and Cardiovascular Surgery 142:1, 166-173
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Paolo Zanatta, Simone Messerotti Benvenuti, Enrico Bosco, Fabrizio Baldanzi, Daniela Palomba, Carlo Valfrè. (2011) Multimodal Brain Monitoring Reduces Major Neurologic Complications in Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia
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Myriam Moret, Philippe Moulin. (2011) Dépistage de l’ischémie myocardique silencieuse des patients diabétiques : modalités et enjeux. La Presse Médicale 40:6, 625-633
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Kengo Maekawa, Tomoko Goto, Tomoko Baba, Atsushi Yoshitake, Kazuhiro Katahira, Tatsuo Yamamoto. (2011) Impaired cognition preceding cardiac surgery is related to cerebral ischemic lesions. Journal of Anesthesia 25:3, 330-336
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Solomon Aronson, Joseph Varon. (2011) Hemodynamic Control and Clinical Outcomes in the Perioperative Setting. Journal of Cardiothoracic and Vascular Anesthesia 25:3, 509-525
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Maximilian Y. Emmert, Burkhardt Seifert, Markus Wilhelm, Jürg Grünenfelder, Volkmar Falk, Sacha P. Salzberg. (2011) Aortic no-touch technique makes the difference in off-pump coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery
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Jan M Dieleman, Judith van Paassen, Diederik van Dijk, M. Sesmu Arbous, Cor J Kalkman, Jan P Vandenbroucke, Geert J van der Heijden, Olaf M Dekkers, Jan M Dieleman. 2011. Prophylactic corticosteroids for cardiopulmonary bypass in adults. .
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Simone Messerotti Benvenuti, Daniela Palomba, Paolo Zanatta, Anna Paola Mazzarolo, Carlo Valfrè. (2011) Biomedical and psychological risk in cardiac surgery: is EuroSCORE a more comprehensive risk measure than Stroke Index?. European Journal of Cardio-Thoracic Surgery 39:5, e102-e106
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Georges Khoueiry, Michael Flory, Nidal Abi Rafeh, Mohammad H. Zgheib, Michael Goldman, Tarek Abdallah, Sashi Wettimuny, Blanche Telesford, Thomas Costantino, Joseph T. McGinn. (2011) Depression, disability, and quality of life after off-pump coronary artery bypass grafting: A prospective 9-month follow-up study. Heart & Lung: The Journal of Acute and Critical Care 40:3, 217-225
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Steven Shea, Marco Di Tullio. (2011) Post-Coronary Artery Bypass Grafting Stroke. Journal of the American College of Cardiology 57:18, 1819-1821
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James L. Rudolph, Edward R. Marcantonio. (2011) Postoperative Delirium. Anesthesia & Analgesia 112:5, 1202-1211
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Hiroo Yamanaka, Yukio Hayashi, Takahiko Kamibayashi, Takashi Mashimo. (2011) Effect of Olprinone, a Phosphodiesterase III Inhibitor, on Balance of Cerebral Oxygen Supply and Demand During Cardiopulmonary Bypass. Journal of Cardiovascular Pharmacology 57:5, 579-583
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Kevin W. Hatton, Jeremy D. Flynn, Christine Lallos, Brenda G. Fahy. (2011) Integrating Evidence-Based Medicine Into the Perioperative Care of Cardiac Surgery Patients. Journal of Cardiothoracic and Vascular Anesthesia 25:2, 335-346
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Gary R.W. Hunter, G. Bryan Young. (2011) Seizures After Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia 25:2, 299-305
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R. Dittrich, E.B. Ringelstein. (2011) Neurologische Komplikationen nach herzchirurgischen Operationen. Zeitschrift für Herz-,Thorax- und Gefäßchirurgie 25:2, 92-98
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Judith A. Hudetz, Kathleen M. Patterson, Zafar Iqbal, Sweeta D. Gandhi, Paul S. Pagel. (2011) Metabolic Syndrome Exacerbates Short-term Postoperative Cognitive Dysfunction in Patients Undergoing Cardiac Surgery: Results of a Pilot Study. Journal of Cardiothoracic and Vascular Anesthesia 25:2, 282-287
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Ramy F. Ayad, Paul S. Bhella, William D. Dockery, Jeffrey M. Schussler. (2011) Patency of Vein Graft Anastomoses Facilitated With the Hexalon Device. The Annals of Thoracic Surgery 91:3, 894-898
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Kaoru Matsuura, Kenji Mogi, Manabu Sakurai, Tomonori Kawamura, Yoshiharu Takahara. (2011) Impact of Preexisting Cerebral Ischemia Detected by Magnetic Resonance Imaging and Angiography on Late Outcome After Coronary Artery Bypass Surgery. The Annals of Thoracic Surgery 91:3, 665-670
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Thomas V. Bilfinger. (2011) Invited Commentary. The Annals of Thoracic Surgery 91:2, 519
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Emilie de Tournay-Jetté, Gilles Dupuis, Louis Bherer, Alain Deschamps, Raymond Cartier, André Denault. (2011) The Relationship Between Cerebral Oxygen Saturation Changes and Postoperative Cognitive Dysfunction in Elderly Patients After Coronary Artery Bypass Graft Surgery. Journal of Cardiothoracic and Vascular Anesthesia 25:1, 95-104
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Julie Huffmyer, Jacob Raphael. (2011) The current status of off-pump coronary bypass surgery. Current Opinion in Anaesthesiology 24:1, 64-69
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Magnus Hedberg, Patrik Boivie, Karl Gunnar Engström. (2011) Early and delayed stroke after coronary surgery — an analysis of risk factors and the impact on short- and long-term survival. European Journal of Cardio-Thoracic Surgery
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Andrew B. Goldstone, David J. Bronster, Anelechi C. Anyanwu, Martin A. Goldstein, Farzan Filsoufi, David H. Adams, Joanna Chikwe. (2011) Predictors and Outcomes of Seizures After Cardiac Surgery: A Multivariable Analysis of 2,578 Patients. The Annals of Thoracic Surgery 91:2, 514-518
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Yuji Kadoi, Chikara Kawauchi, Masanobu Ide, Masataka Kuroda, Kenichiro Takahashi, Shigeru Saito, Nao Fujita, Akio Mizutani. (2011) Preoperative depression is a risk factor for postoperative short-term and long-term cognitive dysfunction in patients with diabetes mellitus. Journal of Anesthesia 25:1, 10-17
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Judith A. Hudetz, Sweeta D. Gandhi, Zafar Iqbal, Kathleen M. Patterson, Paul S. Pagel. (2011) Elevated postoperative inflammatory biomarkers are associated with short- and medium-term cognitive dysfunction after coronary artery surgery. Journal of Anesthesia 25:1, 1-9
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Rosendo A. Rodriguez, Miguel Bussière, Michael Bourke, Thierry Mesana, Howard J. Nathan. (2011) Predictors of Duration of Unconsciousness in Patients With Coma After Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia
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Judith Bellapart, Gregory S Chan, Yu-Chieh Tzeng, Philip Ainslie, Adrian G Barnett, Kimble R Dunster, Rob Boots, John F Fraser. (2011) The effect of Ventricular Assist Devices on cerebral autoregulation: A preliminary study. BMC Anesthesiology 11:1, 4
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Axel Fudickar, Sönke Peters, Claudia Stapelfeldt, Götz Serocki, Jörn Leiendecker, Patrick Meybohm, Markus Steinfath, Berthold Bein. (2011) Postoperative cognitive deficit after cardiopulmonary bypass with preserved cerebral oxygenation: a prospective observational pilot study. BMC Anesthesiology 11:1, 7
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Yang Jin Park, Dong-Ik Kim, Young Nam Roh, Wook Sung Kim, Young Tak Lee, Gyeong-Moon Kim, Duk-Kyung Kim, Young-Wook Kim. (2011) Comparative Results of Combined Coronary Artery Bypass Grafting and Carotid Endarterectomy versus Staged Operation. Journal of the Korean Surgical Society 80:1, 61
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Sebastian Holinski, Benjamin Claus, Nour Alaaraj, Pascal Maria Dohmen, Konrad Neumann, Ralf Uebelhack, Wolfgang Konertz. (2011) Cerebroprotective Effect of Piracetam in Patients Undergoing Open Heart Surgery. Annals of Thoracic and Cardiovascular Surgery 17:2, 137-142
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M. Àngels Font, Jerzy Krupinski, Adrià Arboix. (2011) Antithrombotic Medication for Cardioembolic Stroke Prevention. Stroke Research and Treatment 2011, 1-23
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Sotiris C. Stamou, Marcy Nussbaum, Robert M. Stiegel, Mark K. Reames, Eric R. Skipper, Francis Robicsek, Kevin W. Lobdell. (2011) Effect of Body Mass Index on Outcomes After Cardiac Surgery: Is There an Obesity Paradox?. The Annals of Thoracic Surgery 91:1, 42-47
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Shinji Kanemitsu, Sawaka Tanabe, Kensuke Ohue, Hiroyuki Miyagawa, Yoichiro Miyake, Manabu Okabe. (2011) Improve Morbidity and Mortality in Coronary Artery Bypass Graft Surgery for Severe Atherosclerosis. Annals of Vascular Diseases 4:2, 93-98
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Marco R. Di Tullio, Shunichi Homma. 2011. Atherosclerotic Disease of the Proximal Aorta. , 741-757.
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David M. Greer, Shunichi Homma, Karen L. Furie. 2011. Cardiac Diseases. , 814-827.
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Sharon Gallagher Owens, Jackie Agnew, Barbara Curbow, Ola Selnes, Sheila Fitzgerald. (2010) The Association of Neurocognitive Decline and Other Variables With Return to Work, Hobbies, and Activities of Daily Living After Coronary Artery Bypass Graft Surgery. Physical & Occupational Therapy in Geriatrics 28:4, 348-359
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Judith A. Hudetz, Sweeta D. Gandhi, Zafar Iqbal, Kathleen M. Patterson, Alison J. Byrne, David C. Warltier, Paul S. Pagel. (2010) History of Post-traumatic Stress Disorder Is Associated With Impaired Neuropsychometric Performance After Coronary Artery Surgery. Journal of Cardiothoracic and Vascular Anesthesia 24:6, 964-968
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Hilary P Grocott, Sophie Davie, Christine Fedorow. (2010) Monitoring of brain function in anesthesia and intensive care. Current Opinion in Anaesthesiology 23:6, 759-764
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C. Lichtenstern, M. Müller, J. Schmidt, K. Mayer, M.A. Weigand. (2010) Intensivtherapie nach Transplantation solider Organe. Der Anaesthesist 59:12, 1135-1154
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Patrik Boivie, Magnus Hedberg, Karl Gunnar Engström. (2010) Size distribution of embolic material produced at aortic cross-clamp manipulation. Scandinavian Cardiovascular Journal 44:6, 367-372
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C. Cann, A. R. Wilkes, J. E. Hall, R. A. Kumar. (2010) Are we using our brains? Diagnosis of postoperative cognitive dysfunction. Anaesthesia 65:12, 1166-1169
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Rosebud O. Roberts, David S. Knopman, Yonas E. Geda, Ruth H. Cha, Véronique L. Roger, Ronald C. Petersen. (2010) Coronary heart disease is associated with non-amnestic mild cognitive impairment. Neurobiology of Aging 31:11, 1894-1902
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Marius Berman, David Cardone, Linda Sharples, Alain Vuylsteke, Andrew Klein, Caroline Gerrard, John Dunning, Steven Tsui, David Jenkins. (2010) Safety and Efficacy of Aprotinin and Tranexamic Acid in Pulmonary Endarterectomy Surgery With Hypothermia: Review of 200 Patients. The Annals of Thoracic Surgery 90:5, 1432-1436
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Christian A. Plass, Bruno K. Podesser, Alexander M. Prusa. (2010) Effect of blower-mister devices on vasoreactivity of coronary artery bypass grafts. The Journal of Thoracic and Cardiovascular Surgery 140:4, 923-927
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Sunil M. Prasad, Shuang Li, J. Scott Rankin, Sean M. O’Brien, James S. Gammie, John D. Puskas, David M. Shahian, Edgar G. Chedrawy, Malek G. Massad. (2010) Current Outcomes of Simultaneous Carotid Endarterectomy and Coronary Artery Bypass Graft Surgery in North America. World Journal of Surgery 34:10, 2292-2298
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Reinout J Mildner, Desmond Bohn, Reinout J Mildner. 2010. Colloid versus crystalloid solutions for priming cardiopulmonary bypass circuits. .
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Katherine W. Arendt. 2010. Cardiopulmonary Bypass. , 196-206.
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Michael P. Vallely, Tristan D. Yan, J. James B. Edelman, Mark Hayman, R. John L. Brereton, Donald E. Ross. (2010) Anaortic, Total-arterial, Off-pump Coronary Artery Bypass Surgery: How To Do It. Heart, Lung and Circulation 19:9, 555-560
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B. van Zaane, A. P. Nierich, G. J. Brandon Bravo Bruinsma, P. M. J. Rosseel, F. Z. Ramjankhan, E. E. C. de Waal, W. F. Buhre, K. G. M. Moons. (2010) Diagnostic accuracy of modified transoesophageal echocardiography for pre-incision assessment of aortic atherosclerosis in cardiac surgery patients. British Journal of Anaesthesia 105:2, 131-138
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Judith A. Hudetz, Raymond G. Hoffmann, Kathleen M. Patterson, Alison J. Byrne, Zafar Iqbal, Sweeta D. Gandhi, David C. Warltier, Paul S. Pagel. (2010) Preoperative Dispositional Optimism Correlates With a Reduced Incidence of Postoperative Delirium and Recovery of Postoperative Cognitive Function in Cardiac Surgical Patients. Journal of Cardiothoracic and Vascular Anesthesia 24:4, 560-567
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Jeannette Schoenebeck, Munif Haddad, Karl Wegscheider, Elrina Joubert-Huebner, Hermann Reichenspurner, Christian Detter. (2010) Prospective, Randomized Study Comparing Two Different Minimized Versus Conventional Cardiopulmonary Bypass Systems. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5:4, 270-277
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A. Cassar, D. Poldermans, C. S. Rihal, B. J. Gersh. (2010) The management of combined coronary artery disease and peripheral vascular disease. European Heart Journal 31:13, 1565-1572
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Xiao-Bo Liao, Yi-Qun Peng, Xin-Min Zhou, Bing Yang, Zhe Zheng, Li-Ming Liu, Feng-Lin Song, Jian-Ming Li, Kang Zhou, Ji-Cai Meng, Ling-Qing Yuan, Hui Xie. (2010) Taurine restores Axl/Gas6 expression in vascular smooth muscle cell calcification model. Amino Acids 39:2, 375-383
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Nikola Lakič, Katarina Šurlan, Aleš Jerin, Bernard Meglič, Nina Curk, Matjaž Bunc. (2010) Importance of Erythropoietin in Brain Protection aft er Cardiac Surgery: A Pilot Study. The Heart Surgery Forum 13:3, E185-E189
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Jeremiah G. Allen, Eric S. Weiss, Mary Ann Wilson, George J. Arnaoutakis, Mary E. Blue, C. Conover Talbot, Chunfa Jie, Mary S. Lange, Juan C. Troncoso, Michael V. Johnston, William A. Baumgartner. (2010) Transcriptional Profile of Brain Injury in Hypothermic Circulatory Arrest and Cardiopulmonary Bypass. The Annals of Thoracic Surgery 89:6, 1965-1971
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Yolanda Carrascal, Angel L. Guerrero. (2010) Neurological Damage Related to Cardiac Surgery. The Neurologist 16:3, 152-164
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Nancy A. Nussmeier, Yinghui Miao, Gary W. Roach, Richard L. Wolman, Christina Mora-Mangano, Mark Fox, Andrea Szekely, Concezione Tommasino, Nanette M. Schwann, Dennis T. Mangano. (2010) Predictive value of the National Institutes of Health Stroke Scale and the Mini-Mental State Examination for neurologic outcome after coronary artery bypass graft surgery. The Journal of Thoracic and Cardiovascular Surgery 139:4, 901-912
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H. Mayumi Homi, Carla L. Calvi, J. Lynch, Hilary P. Grocott. (2010) Longitudinal Assessment of Neurocognitive Function in Rats After Cardiopulmonary Bypass: Evidence for Long-Term Deficits. Journal of Cardiothoracic and Vascular Anesthesia 24:2, 293-299
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Adnan Yalcinkaya, Kumral Ergun Cagli, Mahmut M. Ulas, Sarper R. Okten, Kerim Cagli. (2010) Coronary-Coronary Bypass Grafting to Reduce the Risk of Aortic Atheroembolism. Journal of Cardiac Surgery 25:2, 167-169
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Andreas G. Sakopoulos, John G. Jacobson, Don R. Wilson, Wilfred M. Huse. (2010) “Beyond Beating Heart Surgery”. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5:2, 118-121
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Kazuhiro Kurisu, Manabu Hisahara, Yusuke Ando, Ryuji Tominaga. (2010) Bilateral Axillary Artery Perfusion to Reduce Brain Damage during Cardiopulmonary Bypass. Journal of Cardiac Surgery 25:2, 139-142
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Judith A. Hudetz, Paul S. Pagel. (2010) Neuroprotection by Ketamine: A Review of the Experimental and Clinical Evidence. Journal of Cardiothoracic and Vascular Anesthesia 24:1, 131-142
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Christine Fedorow, Hilary P Grocott. (2010) Cerebral monitoring to optimize outcomes after cardiac surgery. Current Opinion in Anaesthesiology 23:1, 89-94
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Bettina Jungwirth, Barbara Eckel, Manfred Blobner, Kristine Kellermann, Eberhard F. Kochs, G Burkhard Mackensen. (2010) The Impact of Cardiopulmonary Bypass on Systemic Interleukin-6 Release, Cerebral Nuclear Factor-kappa B Expression, and Neurocognitive Outcome in Rats. Anesthesia & Analgesia 110:2, 312-320
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Kwok M. Ho, John P. Lewis. (2010) Prevention of Atrial Fibrillation in Cardiac Surgery: Time to Consider a Multimodality Pharmacological Approach. Cardiovascular Therapeutics 28:1, 59-65
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John M. Murkin, Florian Falter, Jeff Granton, Bryan Young, Christiana Burt, Michael Chu. (2010) High-Dose Tranexamic Acid Is Associated with Nonischemic Clinical Seizures in Cardiac Surgical Patients. Anesthesia & Analgesia 110:2, 350-353
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Matthias E Pfisterer, Michael J Zellweger, Bernard J Gersh. (2010) Management of stable coronary artery disease. The Lancet 375:9716, 763-772
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Jan M Dieleman, Judith van Paassen, Diederik van Dijk, Sesmu M Arbous, Cor J Kalkman, Jan P Vandenbroucke, Geert J van der Heijden, Olaf M Dekkers, Jan M Dieleman. 2010. Prophylactic corticosteroids for cardiopulmonary bypass in adults. .
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2010. Post-ICU Care and Other Complications. , 641-725.
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Seonghoon Ko. (2010) Transient decrease of cerebral oxygen saturation during the emergence in children. Korean Journal of Anesthesiology 59:1, 1
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Shady M. Eldaif, Vinod H. Thourani, John D. Puskas. (2010) Cerebral Emboli Generation During Off-Pump Coronary Artery Bypass Grafting With a Clampless Device versus Partial Clamping of the Ascending Aorta. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5:1, 7-11
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Nila J. Akhtar, Alan H. Markowitz, Robert C. Gilkeson. (2010) Multidetector Computed Tomography in the Preoperative Assessment of Cardiac Surgery Patients. Radiologic Clinics of North America 48:1, 117-139
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Ranjit John, Asim F. Choudhri, Alan D. Weinberg, Windsor Ting, Eric A. Rose, Craig R. Smith, Mehmet C. Oz. (2000) Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting. The Annals of Thoracic Surgery 69:1, 30-35
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Dimitrios Georgiadis, Anja Berger, Ellen Kowatschev, Christine Lautenschläger, Angelika Börner, Alfred Lindner, Wilhelm Schulte-Mattler, Hans-Reinhard Zerkowski, Stephan Zierz, Thomas Deufel. (2000) Predictive value of S-100β and neuron-specific enolase serum levels for adverse neurologic outcome after cardiac surgery. The Journal of Thoracic and Cardiovascular Surgery 119:1, 138-147
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Yoshihiro Morino, Kazuhiro Hara, Kengo Tanabe, Yuzo Kuroda, Seiji Ayabe, Ken Kozuma, Ikutaro Kigawa, Sachito Fukuda, Yasuhiko Wanibuchi, Tsutomu Tamura. (2000) Retrospective Analysis of Cerebral Complications After Coronary Artery Bypass Grafting in Elderly Patients. Japanese Circulation Journal 64:1, 46-50
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Jarle Vaage, Ulf Jensen, Anders Eri. (2000) Neurologic Injury in Cardiac Surgery: Aortic Atherosclerosis Emerges as the Single most Important Risk Factor. Scandinavian Cardiovascular Journal 34:6, 550-557
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Eija I. T. Saimanen. (2000) Perioperative Stroke in Coronary Artery Bypass Surgery: Analysis of Risk Factors. Scandinavian Cardiovascular Journal 34:1, 41-45
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G.Burkhard Mackensen, Bengt Nellgård, Shiva Sarraf-Yazdi, Franklin Dexter, Robert P Steffen, Hilary P Grocott, David S Warner. (2000) Post-ischemic RSR13 amplifies the effect of dizocilpine on outcome from transient focal cerebral ischemia in the rat. Brain Research 853:1, 15-21
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C Rokkas. (1999) The severely atherosclerotic ascending aorta: detection and surgical options. ACC Current Journal Review 8:6, 33-36
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R.Alan Hall, David J Fordyce, Marie E Lee, Brian Eisenberg, Richard F Lee, James H Holmes, William G Campbell. (1999) Brain SPECT imaging and neuropsychological testing in coronary artery bypass patients. The Annals of Thoracic Surgery 68:6, 2082-2088
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Deborah S Fruitman, Carolyn E MacDougall, David B Ross. (1999) Cardiac surgery in octogenarians: can elderly patients benefit? quality of life after cardiac surgery. The Annals of Thoracic Surgery 68:6, 2129-2135
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Yuzuru Sakakibara, Kazuro Matsuda, Fujio Sato, Kanji Matsuzaki, Tomoaki Jikuya, Toshio Mitsui. (1999) Aortic dissection complicating cardiac surgery in a patient with calcified ascending aorta. The Japanese Journal of Thoracic and Cardiovascular Surgery 47:12, 625-628
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Hulya Sungurtekin, Walter Plöchl, David J. Cook. (1999) Relationship between Cardiopulmonary Bypass Flow Rate and Cerebral Embolization in Dogs. Anesthesiology 91:5, 1387
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Pamela Williams-Russo, Nigel E. Sharrock, Steven Mattis, Gregory A. Liguori, Carol Mancuso, Margaret G. Peterson, James Hollenberg, Chitranjan Ranawat, Eduardo Salvati, Thomas Sculco. (1999) Randomized Trial of Hypotensive Epidural Anesthesia in Older Adults. Anesthesiology 91:4, 926
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Koichiroh Nandate, Alain Vuylsteke, Alan E. Crosbie, Souad Messahel, Amo Oduro-Dominah, David K. Menon. (1999) Cerebrovascular Cytokine Responses During Coronary Artery Bypass Surgery: Specific Production of Interleukin-8 and Its Attenuation by Hypothermic Cardiopulmonary Bypass. Anesthesia & Analgesia 89:4, 823
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William F Turner. (1999) “Off-pump” coronary artery bypass grafting: the first one hundred cases of the Rose City experience. The Annals of Thoracic Surgery 68:4, 1482-1485
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John M Murkin, W.Douglas Boyd, Sugantha Ganapathy, Sandra J Adams, Rhonda C Peterson. (1999) Beating heart surgery: why expect less central nervous system morbidity?. The Annals of Thoracic Surgery 68:4, 1498-1501
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Michael A. Borger, Ruth L. Taylor, Richard D. Weisel, Girish Kulkarni, Mark Benaroia, Vivek Rao, Gideon Cohen, Ludwig Fedorko, Christopher M. Feindel. (1999) Decreased cerebral emboli during distal aortic arch cannulation: A randomized clinical trial. The Journal of Thoracic and Cardiovascular Surgery 118:4, 740-745
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Kim A. Eagle, Robert A. Guyton, Ravin Davidoff, Gordon A. Ewy, James Fonger, Timothy J. Gardner, John Parker Gott, Howard C. Herrmann, Robert A. Marlow, William C. Nugent, Gerald T. O’Connor, Thomas A. Orszulak, Richard E. Rieselbach, William L. Winters, Salim Yusuf, Raymond J. Gibbons, Joseph S. Alpert, Kim A. Eagle, Timothy J. Gardner, Arthur Garson, Gabriel Gregoratos, Richard O. Russell, Sidney C. Smith. (1999) ACC/AHA guidelines for coronary artery bypass graft surgery. Journal of the American College of Cardiology 34:4, 1262-1347
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Søren Ballegaard, Anne Johannessen, Benny Karpatschof, Jørgen Nyboe. (1999) Addition of Acupuncture and Self-Care Education in the Treatment of Patients with Severe Angina Pectoris May be Cost Beneficial: An Open, Prospective Study. The Journal of Alternative and Complementary Medicine 5:5, 405-413
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A.W. Bracey, R. Radovancevic, S.A. Riggs, S. Houston, H. Cozart, W.K. Vaughn, B. Radovancevic, H.A. McAllister, D.A. Cooley. (1999) Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome. Transfusion 39:10, 1070-1077
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John M. Murkin. (1999) Commentary. The Journal of Thoracic and Cardiovascular Surgery 118:3, 420-421
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John Parker Gott, Vinod H Thourani, Carolyn E Wright, W.Morris Brown, Andrew B Adams, George M Skardasis, William M McKinnon, Patrick M Battey, Robert A Guyton. (1999) Risk neutralization in cardiac operations: detection and treatment of associated carotid disease. The Annals of Thoracic Surgery 68:3, 850-856
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Richard J. Novick, Larry W. Stitt. (1999) The Learning Curve of an Academic Cardiac Surgeon: Use of the CUSUM Method. Journal of Cardiac Surgery 14:5, 312-320
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G.Hossein Almassi, Tracy Sommers, Thomas E Moritz, A.Laurie W Shroyer, Martin J London, William G Henderson, Gulshan K Sethi, Frederick L Grover, Karl E Hammermeister. (1999) Stroke in cardiac surgical patients: determinants and outcome. The Annals of Thoracic Surgery 68:2, 391-397
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Yuji Kadoi, Fuminori Kawahara, Shigeru Saito, Toshihiro Morita, Fumio Kunimoto, Fumio Goto, Nao Fujita. (1999) Effects of hypothermic and normothermic cardiopulmonary bypass on brain oxygenation. The Annals of Thoracic Surgery 68:1, 34-39
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Carl H Wong, Stephen J Rooney, Robert S Bonser. (1999) S-100β release in hypothermic circulatory arrest and coronary artery surgery. The Annals of Thoracic Surgery 67:6, 1911-1914
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Fritz J. Baumgartner, Ali Gheissari, Eli R. Capouya, George P. Panagiotides, Alireza Katouzian, Taro Yokoyama. (1999) Technical aspects of total revascularization in off-pump coronary bypass via sternotomy approach. The Annals of Thoracic Surgery 67:6, 1653-1658
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Dong-Chan Kim, Michael M. Todd. (1999) Forebrain ischemia: effect on pharmacologically induced seizure thresholds in the rat. Brain Research 831:1-2, 131-139
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Carl H Wong, Robert S Bonser. (1999) Does retrograde cerebral perfusion affect risk factors for stroke and mortality after hypothermic circulatory arrest?. The Annals of Thoracic Surgery 67:6, 1900-1903
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Mark H. Wholey. (1999) Do the benefits of angiography outweigh the risks in the treatment of patients with carotid artery occlusive disease?. CardioVascular and Interventional Radiology 22:3, 183-184
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Mario Gaudino, Franco Glieca, Francesco Alessandrini, Carlo Cellini, Nicola Luciani, Claudio Pragliola, Rocco Schiavello, Gianfederico Possati. (1999) Individualized surgical strategy for the reduction of stroke risk in patients undergoing coronary artery bypass grafting11This article has been selected for the open discussion forum on the STS Web site: http://www.sts.org/section/atsdiscussion/. The Annals of Thoracic Surgery 67:5, 1246-1253
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Elliott Bennett-Guerrero, William F Spillane, William D White, Lawrence H Muhlbaier, Stanley A Gall, Peter K Smith, Mark F Newman. (1999) ε-aminocaproic acid administration and stroke following coronary artery bypass graft surgery. The Annals of Thoracic Surgery 67:5, 1283-1287
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Massimo A Mariani, Y.John Gu, Piet W Boonstra, Jan G Grandjean, Willem van Oeveren, Tjark Ebels. (1999) Procoagulant activity after off-pump coronary operation: is the current anticoagulation adequate?. The Annals of Thoracic Surgery 67:5, 1370-1375
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Ola A Selnes, Maura A Goldsborough, Louis M Borowicz, Guy M McKhann. (1999) Neurobehavioural sequelae of cardiopulmonary b ypass. The Lancet 353:9164, 1601-1606
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Vigneshwar Kasirajan, Nicholas G Smedira, John Perl, Patrick M McCarthy. (1999) Cerebral embolism associated with left ventricular assist device support and successful therapy with intraarterial urokinase. The Annals of Thoracic Surgery 67:4, 1148-1150
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Rainer G Leyh, Claus Bartels, Axel Nötzold, Hans-Hinrich Sievers. (1999) Management of porcelain aorta during coronary artery bypass grafting. The Annals of Thoracic Surgery 67:4, 986-988
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Brendan P. Conroy, Damon Black, Cheng Y. Lin, Larry W. Jenkins, Christian R. Crumrine, Douglas S. DeWitt, William E. Johnston. (1999) Lamotrigine Attenuates Cortical Glutamate Release during Global Cerebral Ischemia in Pigs on Cardiopulmonary Bypass. Anesthesiology 90:3, 844-854
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T.K. Safa, S. Friedman, M. Mehta, O. Rahmani, L. Scher, G. Pogo, M. Hall. (1999) Management of Coexisting Coronary Artery and Asymptomatic Carotid Artery Disease: Report of a Series of Patients Treated with Coronary Bypass Alone. European Journal of Vascular and Endovascular Surgery 17:3, 249-252
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Martin Lampa, James Ramsay. (1999) Anesthetic implications of new surgical approaches to myocardial revascularization. Current Opinion in Anaesthesiology 12:1, 3-8
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Walter Plochl, David J. Cook. (1999) Quantification and Distribution of Cerebral Emboli during Cardiopulmonary Bypass in the Swine. Anesthesiology 90:1, 183-190
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C.Thomas Wass, Julian R Waggoner, David G Cable, Hartzell V Schaff, Darrell R Schroeder, William L Lanier. (1998) Selective convective brain cooling during hypothermic cardiopulmonary bypass in dogs. The Annals of Thoracic Surgery 66:6, 2008-2014
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Toshiki Takahashi, Shigeaki Ohtake, Takayoshi Ueno, Masahiro Koh, Yoshiki Sawa, Hikaru Matsuda. (1998) Off-pump coronary bypass using interposed radial artery graft. The Annals of Thoracic Surgery 66:6, 2096-2098
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Christopher M. Ryan, Rick Hendrickson. (1998) Evaluating the Effects of Treatment for Medical Disorders: Has the Value of Neuropsychological Assessment Been Fully Realized?. Applied Neuropsychology 5:4, 209-219
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A H S Lee, P J Gallagher. (1998) Post-mortem examination after cardiac surgery. Histopathology 33:5, 399-405
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Marco Zenati, Howard A. Cohen, Richard Holubkov, A.J. Conrad Smith, Arthur J. Boujoukos, John Caldwell, Leonard Firestone, Bartley P. Griffith. (1998) Preoperative risk models for minimally invasive coronary bypass: A preliminary study. The Journal of Thoracic and Cardiovascular Surgery 116:4, 584-589
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Paula M. Bokesch, Peter A. Seirafi, Kenneth G. Warner, James E. Marchand, Richard M. Kream, Bruce Trapp. (1998) Differential Immediate-early Gene Expression in Ovine Brain after Cardiopulmonary Bypass and Hypothermic Circulatory Arrest. Anesthesiology 89:4, 961-968
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Joseph De Gregorio, Yoshio Kobayashi, Remo Albiero, Bernhard Reimers, Carlo Di Mario, Leo Finci, Antonio Colombo. (1998) Coronary artery stenting in the elderly: short-term outcome and long-term angiographic and clinical follow-up. Journal of the American College of Cardiology 32:3, 577-583
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Robert C. King, R.Chai Kanithanon, Kimberly S. Shockey, William D. Spotnitz, Curtis G. Tribble, Irving L. Kron. (1998) Replacing the atherosclerotic ascending aorta is a high-risk procedure. The Annals of Thoracic Surgery 66:2, 396-400
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Norman Delanty, Carl J Vaughan, Jacqueline A French. (1998) Medical causes of seizures. The Lancet 352:9125, 383-390
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Paul J Silver, Richard Broughton, Josee Bouthillier, Timothy A Quinn, Annette M Wallace, Ronald E Weishaar. (1998) Neutralase™ Reverses the Anti-coagulant but Not the Anti-thrombotic Activity of Heparin in a Rabbit Model of Venous Thrombosis. Thrombosis Research 91:3, 143-150
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Frank Hanel, Georg von Knobelsdorff, Christian Werner, Jochen Schulte Esch. (1998) Hypercapnia Prevents Jugular Bulb Desaturation during Rewarming from Hypothermic Cardiopulmonary Bypass. Anesthesiology 89:1, 19-23
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Janice Russell, Naotsuka Okayama, J.Steven Alexander, D.Neil Granger, Carleton J.C Hsia. (1998) Pretreatment with Polynitroxyl Albumin (PNA) Inhibits Ischemia-Reperfusion Induced Leukocyte-Endothelial Cell Adhesion 11This work is supported in-part by grants from the National Institutes of Health, NS 36119 (CJCH) and HL26441 (DNG).. Free Radical Biology and Medicine 25:2, 153-159
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J Bergsland. (1998) Elimination of cardiopulmonary bypass: a prime goal in reoperative coronary artery bypass surgery. European Journal of Cardio-Thoracic Surgery 14:1, 59-63
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Jonathan M. Philpott, Thomas D. Eskew, You Su Sun, Kathy J. Dennis, Brett H. Foreman, Scott N. Fairbrother, Philip M. Brown, Theodore C. Koutlas, W.Randolph Chitwood, Robert M. Lust. (1998) A Paradox of Cerebral Hyperperfusion in the Face of Cerebral Hypotension: The Effect of Perfusion Pressure on Cerebral Blood Flow and Metabolism during Normothermic Cardiopulmonary Bypass. Journal of Surgical Research 77:2, 141-149
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Paul G. Yock. (1998) The Future of Minimally Invasive Myocardial Revascularization: A Cardiologist's View. Journal of Cardiac Surgery 13:4, 310-315
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Michael J. Mack, Tea Acuff, John Osborne. (1998) Minimally Invasive Direct Coronary Artery Bypass: Technical Considerations and Instrumentation. Journal of Cardiac Surgery 13:4, 290-296
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WILLIAM A. BAUMGARTNER, J. MARK REDMOND, KENTON J. ZEHR, MALCOLM V. BROCK, ELAINE E. TSENG, MARY E. BLUE, JUAN C. TRONCOSO, MICHAEL V. JOHNSTON. (1998) The Role of the Monosialoganglioside, GM1, as a Neuroprotectant in an Experimental Model of Cardiopulmonary Bypass and Hypothermic Circulatory Arresta. Annals of the New York Academy of Sciences 845:1 SPHINGOLIPIDS, 382-390
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Henrik Jönsson, Per Johnsson, Christer Alling, Stephen Westaby, Sten Blomquist. (1998) Significance of Serum S100 Release After Coronary Artery Bypass Grafting. The Annals of Thoracic Surgery 65:6, 1639-1644
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C.Thomas Wass, Julian Waggoner III, David G. Cable, Hartzell V. Schaff, Darrell R. Schroeder, William L. Lanier. (1998) Selective convective brain cooling during normothermic cardiopulmonary bypass in dogs. The Journal of Thoracic and Cardiovascular Surgery 115:6, 1350-1357
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HARVEY L. EDMONDS, IGOR SINGER, AIDA SEHIC, TED J. STRICKLAND. (1998) Multimodality Neuromonitoring for Neurocardiology. Journal of Interventional Cardiology 11:3, 197-204
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Robin H. Heijmen, Cornelius Borst, Rob van Dalen, Paul F. Gründeman, Cees W.J. Verlaan. (1998) Temporary Luminal Arteriotomy Seal for Bypass Grafting. The Annals of Thoracic Surgery 65:4, 1093-1099
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David Royston. (1998) Aprotinin Versus Lysine Analogues: The Debate Continues. The Annals of Thoracic Surgery 65:4, S9-S19
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Bradley J. Hindman, Franklin Dexter, Sakae Enomoto, Alberto Subieta, Tom Smith, Johann Cutkomp. (1998) Recovery of Evoked Potential Amplitude after Cerebral Arterial Air Embolism in the Rabbit. Anesthesiology 88:3, 696-707
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Cathy A. Sila. (1998) NEUROLOGIC COMPLICATIONS OF VASCULAR SURGERY. Neurologic Clinics 16:1, 9-20
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Gabriel S Aldea, Paul O’Gara, Oz M Shapira, Patrick Treanor, Ashraf Osman, Eva Patalis, Charles Arkin, Rhea Diamond, Viken Babikian, Harold L Lazar, Richard J Shemin. (1998) Effect of Anticoagulation Protocol on Outcome in Patients Undergoing CABG With Heparin-Bonded Cardiopulmonary Bypass Circuits. The Annals of Thoracic Surgery 65:2, 425-433
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Brendan P. Conroy, Cheng Y. Lin, Larry W. Jenkins, Douglas S. DeWitt, Mark H. Zornow, Tatsuo Uchida, William E. Johnston. (1998) Hypothermic Modulation of Cerebral Ischemic Injury during Cardiopulmonary Bypass in Pigs. Anesthesiology 88:2, 390-402
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Farrah Kheradmand, Jeanine P. Wiener-Kronish, David B. Corry. (1997) ASSESSMENT OF OPERATIVE RISK FOR PATIENTS WITH ADVANCED LUNG DISEASE. Clinics in Chest Medicine 18:3, 483-494
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Anne Rogers, David Stump, Laura Coker, Neal Kon, Robert Brooker. (1997) A126 Does Insulin Treatment Improve Neurobehavioral Outcome Following Coronary Artery Bypass Grafting?. Anesthesiology 87:Supplement, 126A
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JJM Ligtenberg, ARJ Girbes. (1997) Different criteria for pharmacological and surgical treatment of hypertension. The Lancet 350:9073, 294
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Cornelius Borst, William P. Santamore, Nicholas G. Smedira, Johan J. Bredée. (1997) Minimally invasive coronary artery bypass grafting: On the beating heart and via limited access. The Annals of Thoracic Surgery 63:6, S1-S5
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