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J Thorac Cardiovasc Surg 2006;131:540-546
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Impaired baseline regional cerebral perfusion in patients referred for coronary artery bypass

Robert Moraca, MD b , * , Eugene Lin, MD c , James H. Holmes, IV, MD d , David Fordyce, PhD a , William Campbell, PA-C a , Mary Ditkoff, PA-C a , Mark Hill, MD a , Steven Guyton, MD a , Daniel Paull, MD a , R. Alan Hall, MD a

a Department of Cardiothoracic Surgery, Virginia Mason Medical Center, Seattle, Wash
b Department of General Surgery, Virginia Mason Medical Center, Seattle, Wash
c Department of Radiology, Virginia Mason Medical Center, Seattle, Wash
d Burn Service, Wake Forest University, Winston-Salem, N.C

Read at the Thirty-first Annual Meeting of The Western Thoracic Surgical Association, Victoria, BC, Canada, June 22-25, 2005.

Received for publication July 7, 2005; revisions received October 10, 2005; accepted for publication October 20, 2005.

* Address for reprints: Robert J. Moraca, MD, Virginia Mason Medical Center, 5405 Baker Ave NW, Seattle, WA, 98107 (Email: robert.moraca{at}vmmc.org).

BACKGROUND: Cognitive dysfunction and cerebral vascular accidents remain some of the most devastating problems related to cardiac surgery. Despite the major advances in perioperative care and operative technique in coronary artery bypass, this cohort of patients appears to have poor cerebral physiologic reserve. The aim of this study was to describe regional cerebral perfusion of patients with coronary artery disease referred for coronary artery bypass grafting.

METHODS: Eighty-two consecutive patients with coronary artery disease referred for coronary artery bypass grafting were enrolled after providing informed consent in an institutional review board–approved study. Patients with prior cerebral vascular accident, transient ischemic attacks, head trauma, or other neurologic afflictions were excluded from the study. We prospectively measured preoperative regional cerebral perfusion using single photon emission computed tomography (SPECT) imaging of 12 regions. Patients were determined to have an abnormal SPECT if regional cerebral perfusion was less than 2 standard deviations below the mean of age-matched controls.

RESULTS: The mean age was 67.5 (range, 34-89) years. The study group comprised 22% women and 78% men with known risk factors for atherosclerosis: current tobacco use (30%), hypertension (69%), and diabetes (27%). Seventy-five percent of the SPECT scans demonstrated abnormal regional cerebral perfusions, which were associated with older age (P < .008), current tobacco use (P < .005), and diabetes mellitus (P < .005). The incidence of postoperative cerebral vascular accident was 5% and only occurred in patients with abnormal regional cerebral perfusion.

CONCLUSION: Seventy-five percent of patients undergoing coronary bypass grafting have a significant impairment in regional cerebral perfusion compared with published age-matched controls, which may contribute to their proclivity for cerebral complications.

Abbreviations and Acronyms CVA = cerebral vascular accidents; CT = computed tomography; CABG = coronary artery bypass grafting; CAD = coronary artery disease; CVA = cerebral vascular accident; LVEF = left ventricular ejection fraction; LOS = length of stay; MRI = magnetic resonance imaging; rCP = regional cerebral perfusion; SPECT = single photon emission computed tomography; 99mTc = technetium-99m; TIA = transient ischemic attack




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