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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Dr Van Dijk and colleagues¹ found no difference in 12-month cognitive outcomes between patients who underwent either on-pump or off-pump coronary artery bypass grafting (CABG). Although the authors alluded to a possible role of microemboli, they did not provide an explanation for the disturbing frequency and permanency of memory loss and dementia following CABG.

It is possible that patients with extremely low hemoglobin levels may be at higher risk for cognitive deficits following CABG. The current practice of performing cardiac surgery on patients with hematocrits as low as 18% has not been adequately evaluated.² Preoperative transfusions to hematocrits as high as 33% may increase survival.³ Valeri et al⁴ estimated that as many as 40 000 myocardial infarctions per million surgical procedures were caused by undertransfusion.

Patients who have coronary atherosclerosis are more likely to have similar lesions throughout the body, including in the carotid and cerebral vasculature. Oxygen . . . [Full Text of this Article]

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Cognitive Outcome After Off-Pump and On-Pump Coronary Artery Bypass Graft Surgery: A Randomized Trial
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