This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Henry M. Tufo, MD; Adrian M. Ostfeld, MD; Richard Shekelle, PhD

JAMA. 1970;212(8):1333-1340.

Abstract
A prospective study of the conditions of 100 open-heart surgery patients elicited more precise information about incidence, characteristics, and causes of central nervous system dysfunctions after surgery. Neurological, psychometric, and behavioral observations were made preoperatively and postoperatively. Half the sample developed neurological damage following recovery from anesthesia. Forty-three percent of survivors developed behavioral abnormalities preceded by focal neurological damage; intellectual functions were depressed in all such patients. In most patients neurological signs and mental symptoms disappeared and mental status normalized by discharge. However, 15% of survivors had signs of cerebral damage at discharge. Cerebral damage was significantly related to increasing age and depression of arterial pressure. In patients with cerebral dysfunction, arterial pressure fell to levels which did not support adequate cerebral perfusion. Older patients were especially vulnerable to such effects. Neuropathological findings suggested cerebral ischemia.

Author Affiliations
From the departments of preventive medicine, internal medicine, and surgery, University of Illinois College of Medicine and the Prsebyterian-St. Lukes Hospital, Chicago. Dr. Ostefeld is now with the Yale University School of Medicine, New Haven, Conn.

Footnotes
Reprint requests to 60 College St, New Haven, Conn 06510 (Dr. Ostfeld).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Optimal Perfusion During Cardiopulmonary Bypass: An Evidence-Based Approach
Murphy et al.
Anesth. Analg. 2009;108:1394-1417.
ABSTRACT | FULL TEXT  

Watershed Strokes After Cardiac Surgery: Diagnosis, Etiology, and Outcome
Gottesman et al.
Stroke 2006;37:2306-2311.
ABSTRACT | FULL TEXT  

Correlates of Neurocognitive Function of Patients After Off-Pump Coronary Artery Bypass Surgery
Sendelbach et al.
Am J Crit Care 2006;15:290-298.
ABSTRACT | FULL TEXT  

Evaluation of coated oxygenators in cardiopulmonary bypass systems and their impact on neurocognitive function
Khosravi et al.
Perfusion 2005;20:249-254.
ABSTRACT  

A syndromal analysis of neuropsychological outcome following coronary artery bypass graft surgery
Kneebone et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:1121-1127.
ABSTRACT | FULL TEXT  

Operative outcome of simultaneous carotid and valvular surgery
Yoda et al.
Ann. Thorac. Surg. 2004;78:549-555.
ABSTRACT | FULL TEXT  

Pathogenesis of Malaria and Clinically Similar Conditions
Clark et al.
Clin. Microbiol. Rev. 2004;17:509-539.
ABSTRACT | FULL TEXT  

Presurgical Depression Predicts Medical Morbidity 6 Months After Coronary Artery Bypass Graft Surgery
Burg et al.
Psychosom. Med. 2003;65:111-118.
ABSTRACT | FULL TEXT  

The Effect of Lidocaine on Early Postoperative Cognitive Dysfunction After Coronary Artery Bypass Surgery
Wang et al.
Anesth. Analg. 2002;95:1134-1141.
ABSTRACT | FULL TEXT  

Neuropsychological Testing: Methodology, Interpretation and Outcomes
Stump
SEMIN CARDIOTHORAC VASC ANESTH 2002;6:27-33.
ABSTRACT  

LONG-TERM RESULTS OF SIMULTANEOUS CAROTID ENDARTERECTOMY AND MYOCARDIAL REVASCULARIZATION WITH CARDIOPULMONARY BYPASS USED FOR BOTH PROCEDURES
Minami et al.
J. Thorac. Cardiovasc. Surg. 2000;119:764-772.
ABSTRACT | FULL TEXT  

Impaired Clearance of Emboli (Washout) Is an Important Link Between Hypoperfusion, Embolism, and Ischemic Stroke
Caplan and Hennerici
Arch Neurol 1998;55:1475-1482.
ABSTRACT | FULL TEXT  

Perfusion Imaging of the Brain by B-Mode Ultrasonography : An Experimental Study in Rabbits
Itoh et al.
Stroke 1995;26:2353-2357.
ABSTRACT | FULL TEXT  

Risk Factors for Cerebral Injury and Cardiac Surgery
Mills
Ann. Thorac. Surg. 1995;59:1296-1299.
ABSTRACT | FULL TEXT  

Predictors of Cognitive Decline After Cardiac Operation
Newman et al.
Ann. Thorac. Surg. 1995;59:1326-1330.
ABSTRACT | FULL TEXT  

Selection and Clinical Significance of Neuropsychologic Tests
Stump
Ann. Thorac. Surg. 1995;59:1340-1344.
ABSTRACT | FULL TEXT  

Cerebral Dysfunction After Cardiac Surgery: Closing Address
Smith
Ann. Thorac. Surg. 1995;59:1359-1362.
FULL TEXT  

Postoperative Delirium: A Review of 80 Primary Data-Collection Studies
Dyer et al.
Arch Intern Med 1995;155:461-465.
ABSTRACT  

Prolonged Aortic Cross-Clamping Time and Cardiopulmonary Bypass Time Have a Gradient Effect on Early Mortality in Open-Heart Surgery
Sivertssen et al.
VASC ENDOVASCULAR SURG 1995;29:91-97.
ABSTRACT  

Hypothermic circulatory arrest in operations on the thoracic aortaDeterminants of operative mortality and neurologic outcome
Ergin et al.
J. Thorac. Cardiovasc. Surg. 1994;107:788-799.
ABSTRACT | FULL TEXT  

Cerebral dysfunction after cardiopulmonary bypass: aetiology, manifestations and interventions
Campbell and Raskin
Perfusion 1990;5:251-260.
ABSTRACT  

Review article : Gaseous microemboli: a review
Butler and Kurusz
Perfusion 1990;5:81-99.
 

The incidence and nature of neurological morbidity following cardiac surgery: a review
Shaw
Perfusion 1989;4:83-91.
 

The incidence and nature of neuropsychological morbidity following cardiac surgery
Newman
Perfusion 1989;4:93-100.
 

Assessment of cerebrovascular microembolism by retinal fluorescein angiography
Blauth
Perfusion 1989;4:123-129.
 

Filtration in cardiopulmonary bypass: past, present and future
Marshall
Perfusion 1988;3:135-147.
 

Clinical Features of Ischemia in Cerebral Arterial Border Zones After Periods of Reduced Cerebral Blood Flow
Howard et al.
Arch Neurol 1987;44:934-940.
ABSTRACT  

A clinical evaluation of the performance characteristics of one membrane and five bubble oxygenators: gas transfer and gaseous microemboli production
Pearson et al.
Perfusion 1986;1:15-27.
ABSTRACT  

Total Artificial Heart Implantation
Berenson and Grosser
Arch Gen Psychiatry 1984;41:910-916.
ABSTRACT  

Cerebral Outcome After Extracorporeal Circulation: Comparison Between Prospective and Retrospective Evaluations
Sotaniemi
Arch Neurol 1983;40:75-77.
ABSTRACT  

Neuropsychologic Outcome After Open-Heart Surgery
Sotaniemi et al.
Arch Neurol 1981;38:2-8.
ABSTRACT  

Heart Surgery
Blacher and Cleveland
JAMA 1979;242:2463-2464.
ABSTRACT  

A Planned Approach to Coexistent Cerebrovascular Disease in Coronary Artery Bypass Candidates
Mehigan et al.
Arch Surg 1977;112:1403-1409.
ABSTRACT  

The High Rate of Psychiatric Disorders in Elderly Cardiac Patients
Schuckit
ANGIOLOGY 1977;28:235-247.
 

Cerebral Air Embolism: Report of Five Cases and Review of the Literature
Menkin and Schwartzman
Arch Neurol 1977;34:168-170.
ABSTRACT  

Personality and Psychological Factors in Postcardiotomy Delirium
Kornfeld et al.
Arch Gen Psychiatry 1974;31:249-253.
ABSTRACT  

Usefulness of Psychiatric Intervention in Patients Undergoing Cardiac Surgery
Surman et al.
Arch Gen Psychiatry 1974;30:830-835.
ABSTRACT  

The Hidden Psychosis of Open-Heart Surgery: With a Note on the Sense of Awe
Blacher
JAMA 1972;222:305-308.
ABSTRACT  

Cerebral Embolism: Review and Current Perspectives
Calkins
Arch Intern Med 1972;130:430-436.
ABSTRACT  

The Experience of Open Heart Surgery: III. Toward a Definition and Understanding of Postcardiotomy Delirium
Kimball
Arch Gen Psychiatry 1972;27:57-63.
ABSTRACT  

Experience Using a New Dacron Wool Filter During Extracorporeal Circulation
Hill et al.
Arch Surg 1970;101:649-652.
ABSTRACT  

Open-Heart Surgery and The Psyche
Kornfeld
JAMA 1970;213:1343-1344.
ABSTRACT