Cerebral complications in conventional coronary bypass graft surgery
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Published:
Sep 20, 2011
Keywords:
Cerebral complications Post CABG cerebral complications Coronary bypass CABG
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Abstract
Four decades ago, after on-pump coronary artery bypass graft surgery (CABG) was introduced for treating symptomatic coronary artery disease (CAD), operative mortality had continuously declined to below 5%.1-3 While the mortality had fallen, the operative morbidity had been rising as CABG gradually enrolled more complicated elderly cases with advanced CAD and co-morbidities.1-4 Among surgical morbidity, cerebral complications were the most devastating events, since they increased the length of stay, medical expense as well as hospital mortality.5-19 Although the available data showed the declining incidence of peri-operative CNS injury, the incidence of overt cases still varied from 2-7%.20, 21
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Veerakul G, Visudharom K. Cerebral complications in conventional coronary bypass graft surgery. BKK Med J [Internet]. 2011 Sep. 20 [cited 2024 Dec. 24];2(1):58. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/217759
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References
1. Califf RM, Harrell FE, Lee KL, et al. Changing efficacy of coronary revascularization: implications for patient selection. Circulation 1988;78(supplI):185-91.
2. Hammermeister KE, Burchfiel C, Johnson R, et al. Identification of patients at greater risk for developing major complications at cardiac surgery. Circulation 1990;82 (suppl IV):380-9.
3. Jones EL, Weintraub WS, Craver J, et al. Coronary bypass surgery: is the operation different today? J Thorac Cardiovasc Surg 1991;101;108-15.
4. Akins CW, Dagett WM, Vlahakes GJ, et al. Cardiac Operations in Patients 80 Years Old and Older. Ann Thorac Surg 1997;64:606-15.
5. Morrison D, Sartravaha K, Veerakul G. Cerebrovascular and peripheral vascular co-morbidity in High-Risk Cardiac Revascularization and Clinical Trials. Martin Dunitz 2002:373-86.
6. Khan AH, Khilji SA. Neurological outcome after coronary bypass surgery. J Ayub Med Coll Abbottabad 2005 ;17:18-21.
7. Roach GW, Kanchuger M, Mangano CM, et al. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med 1996; 335:1857-63.
8. Barbut D, Caplan LR. Brain Complications of Cardiac Surgery. Current Problems in Cardiology 1997; 22: 451-80.
9. Gardner TJ, Horneffer PJ, Manolio TA, et al. Stroke following coronary artery bypass grafting: a ten-year study. Ann Thorac Surg 1985;40:574-81.
10. Breuer AC, Furlan AJ, Hanson MR, et al. Central nervous system complications of coronary artery bypass graft surgery: prospective analysis of 421 patients. Stroke 1983; 14:682-7.
11. Newman MF, Wolman R, Kanchuger M, et al. Multicenter preoperative stroke risk index for patients undergoing coronary artery bypass graft surgery, Multicenter Study of Perioperative Ischemia (McSPI) Research Group. Circulation 1996;94(Suppl II):74-80.
12. Shaw PJ, Bates D, Cartlidge NEF, et al. Early neurological complications of coronary artery bypass surgery. Br Med J(Clin Res Ed) 1985;291:1384-7.
13. Aberg T. Effect of open-heart surgery on intellectual function. Scand J Thorac Cardiovasc Surg 1974;15:1-63.
14. Sotaniemi KA, Mononen H, Hokkeanen TE. Longterm cerebral outcome after open-heart surgery: a five-year neuropsychologic follow up study. Stroke 1986;17:410-6.
15. Shaw PJ, Bates D, Cartlidge NE, et al. Early intellectual dysfunction following bypass surgery. Q J Med 1986;58 :59-68.
16. Murkin JM, Martzke JS, Buchan AM, et al. A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary bypass surgery: Part 2: neurologic and cognitive outcomes. J Thorac Cardiovasc Surg 1995;110:349-62.
17. Venn G, Klinger L, Smith P. Neuropschychologic sequelae of bypass twelve months after coronary artery surgery. Br Heart J 1987;57:567.
18. Marzke JS, Murkin JM, Baird DL, et al. Perioperative predictors of neuropsychological outcome 3 years after coronary bypass surgery (abstract). Anesth Analg 1996; 82:SCA37.
19. McKhann GM, Seines OA, Goldsborough MA, et al. Cognitive outcomes after coronary artery bypass grafting: five-year neuropsychological followup. Ann Thorac Surg 1997;63:510-5.
20. Pompilino G, Lotto AA, Agrifoglio M, et al. Nonembolic predictors of stroke risk in coronary artery bypass patients. World J Surg 1999;23 :653-7.
21. Neville MJ, Butterworth J, James RL, et al. Similar neuro behavioral outcome after valve or coronary operations despite differing carotid embolic counts. J Thorac Cardiovasc Surg 2001;121:125-36.
22. Kadoi Y, Saito S, Fujita N et al. Risk factors for cognitive dysfunction after coronary artery bypass graft surgery in patients with type 2 diabetes. J Thorac Cardiovasc Surg 2005;129:576-83.
23. Wareing TH, Davila-Roman VG, Barzilai B, et al. Management of the severely atherosclertic ascending aorta during cardiac operations. J Thorac Cardiovasc Surg 1992;103:453-62.
24. Wareing TH, Davila-Roman VG, Daily BB, et al. Strategy for the reduction of stroke incidence in cardiac surgical patients. Ann Thorac Surg 1993;55:1400-8.
25. Bar-El Y, Goor DA. Clamping of the atherosclerotic ascending aorta during coronary bypass operations: its cost in strokes. J. Thorac Cardiovasc Surg 1992; 104:469-74.
26. Davila-Roman VG, Barzilai B, Wareing TH, et al. Atherosclerosis of the ascending aorta: Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. Stroke 1994;25:2010-6.
27. Bolotin G, Domany Y, de Perini L, et al. Use of Intraoperative Epiaortic Ultrasoundsonography To Delineate Aortic Ath eroma. Chest 2005;127:60-5.
28. Fayad ZA, Nahaer T, Fallon JT, et al. In vivo magnetic resonance evaluation of atherosclerotic plaques in the human thoracic aorta: a comparison with transesophageal echocardiography. Circulation 2000;101:2503-9.
29. Barbut D, Yao FS, Hagger DN, et al. Comparison of Transcranial Doppler Ultrasonography and Transesophageal Echocardiography to monitor Emboli During Coronary Artery Bypass Surgery. Stroke 1996;27:87-90.
30. Barbut D, Yao FS, Lo YW, et al. Determination of size of aortic emboli and embolic load during coronary artery bypass grafting. Ann Thorac Surg 1997;63:1262-7.
31. Schwartz LB, Bridgman AH, Keiffer RW, et al. Asymptomatic C arotid Artery Stenosis and stroke in patients undergoing cardiopulmonary bypass. J Vas Surg 1995;21:146-53.
32. Clark RE, Brillman J, Davis DA, et al. Microemboli during coronary artery bypass grafting: genesis and effect on outcome. J Thorac Cardiovasc Surg 1995;109:249-58.
33. Pugsley W, Klinger L, Paschalis C, et al. The impact of microemboli during cardiopulmonary bypass on neuro psychologic functioning. Stroke 1994;25:1393-9.
34. Wolman RL, Kanchuger MS, Newman MF, et al. Adverse neurologic outcome following cardiac surgery. Anesth Analg 1994;78:484.
35. Barbut D, Hinton RB, Szatrowski TP, et al. Cerebral emboli detected during bypass surgery are associated with clamp removal. Stroke 1994;25:2398-402.
36. Frost L, Molgaad H, Christiansen EH, et al. Atrial fibrillation and flutter after coronary bypass surgery: epidemiology, risk factors, and preventive trials. Int J Cardiol 1992;36:253-61.
37. Cox JL. A Perspective of Postoperative Atrial Fibrillation in Cardiac Operations. Ann Thorac Surg 1993;56:405-9.
38. Almassi GH, Schowalter T, Nicolosi AC, et al. Atrial Fibrillation After Cardiac Surgery. Ann Surg 1997; 226:501-13.
39. Ngaage DL, Schaff HV, Mullany CJ, et al. Does preoperativeatrial fibrillation influence early and late outcomes of coronary artery bypass grafting? J Thorac cardiovasc Surg 2007;133:182-9.
40. Mariscalco G, Klersy C, Zanobini M, et al. Atrial f ibrillation after isolated coronary surgery affects late survival. Circulation 2008;118:1612-8.
41. Aijns W, Kolh P, Danchin N, et al. Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Hear J 2010;31: 2501-5.
42. Salasidis, GC, Latter, DA, Steinmetz, OK, et al. Carotid artery duplex scanning in preoperative assessment for coronary artery revascularization: the association between peripheral vascular disease, carotid artery stenosis, and stroke. J Vasc Surg 1995;21:154-60.
43. Oka Y, Inoue T, Hong Y, Sisto DA, et al. Retained intracardiac air: transesophageal echocardiography for definition of incidence and monitoring by improved techniques. J Thorac Cardiovasc Surg 1986;91:329-38.
44. Topol EJ, Humphrey LS, Borkon M, et al. Value of intraoperative left ventricular microbubbles detected by tranesophageal two-dimensional echocardiopgraphy in predicting neurologic outcome after cardiac operations. Am J Cardiol 1985;56:773-5.
45. Tufo HM, Osffeld AM, Shekelle R. Central nervous system dysfunction following open-heart surgery. JAMA 1970; 212:1333-40.
46. Gold JP, Charlson ME, Williams-Russo P, et al. Improvement of outcome after coronary artery bypass: a randomized trial comparing intraoperative high vs low mean arterial pressure. J Thorac Cardiovasc Surg 1995; 110:1302-14.
47. Benetti FJ, Mariani MA, Sani G, et al. Video assisted mini-invasive coronary surgery without cardiopulmonary bypass: a multicenter study. J Thorac Cardiovasc Surg 1996;112:1478-84.
48. Lytle BW, Sabik JF. On-Pump and Off-Pump Bypass Surgery, Tool for revascularization. Circulation 2004; 109:810-2.
49. Arom KV, Flavin TF, Emery RW, et al. Safety and efficacy of offpump coronary bypass grafting. Ann Thorac Surg 2000;69:704-10.
50. Cleveland J, Shroyer A LW, Chen A Y, et al. Off-pump coronary bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 2001;72:1282-9.
51. Hannan EL, Wu C, Smith CR, et al. Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery: Differences in Short-term Outcomes and in Long-term Mortality and Need for Subsequent Revascularization. Circulation 2007;116:1145-52.
52. Van Dijk D, Nierich AP, Jansen EWL, et al. Early outcome after off-pump versus on-pump coronary bypass surgery: Results from a randomized study. Circulation 2001:104:1761-6.
53. Angelini GD, Taylor FC, Reeves BC, et al. Early and midterm outcome after off-pump and on-pump surgery in beatingheart against cardioplegic arrest studies (BHACAS 1 and 2); a pooled analysis of two randomized controlled trials. Lancet 2002;359:1194-9.
54. Shroyer AL, Grover FL, Hattler B, et al. for the VA Randomized On/Off Bypass (ROOBY) Study Group. On-Pump versus Off-Pump Coronary- Artery Bypass Surgery 2009:361(9);1827-37.
55. Morris CD, Eagle K, O’Rourke RA, et al. Coronary Artery Bypass Graft Surgery. In: V Fuster editor. The AHA Guidelines and Scientific Statements Handbook. American Heart Association, Wiley-Blackwell 2009:134-51.
56. King SB , Lembo NJ, Weintraub WS, et al. A randomized trial comparing coronary angioplasty with coronary bypass surgery: Emory Angioplasty Versus Surgery Trail (EAST): N Engl J Med 1994;331:1044-50.
57. Kosinski As, Barnhart HX, Weintraub WS, et al. Five year outcome after coronary angioplasty or coronary surgery: result from the Emory Angioplasty Versus Surgery Trail (EAST) : Circulation 1995;91(suppl I):543.
58. Scott J Hoffman SJ, Holmes DR Jr, Rabinstein AA, et al. Trends, Predictors and Outcomes of Cerebrovascular Events Related to Percutaneous Coronary Intervention. J Am Coll Cardiol Intv 2011;4:415-22.
59. Hlatsky MA, Boothroyd DB, Bravata DM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease : a collaborative analysis of individual patient data from ten randomized trials. Lancet 2009;373:1190-7.
60. Aziz O, Rao C, Panesar SS, et al. Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery. BMJ 2007;334:617.
61. Kapoor JR, Gienger AL, Ardehali R, et al. Isolated disease of the proximal left anterior descending artery comparing the effectiveness of percutaneous coronary interventions and coronary artery bypass surgery. JACC Cardiovasc Interv 2008;1:483-91.
62. Holzhey DM, Jacobs S, Mochalski M, et al. Minimally invasive hybrid coronary artery revascularization. Ann Thorac Surg 2008;86:1856-60.
63. Kon ZN, Brown EN, Tran R, et al. Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared from conventional offpump coronary bypass. J Thorac Cardiovasc Surg 2008;135:367-75.
64. Ederle J, Dobson J, Featherstone RL, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomized controlled trial. Lancet 2010;375:985-97.
65. Brott TG, Hobson RW, Howard G, et al. Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis. N Engl J Med 2010;363:11-23.
66. Ederle J, Featherstone RL, Brown MM. Randomized controlled trials comparing endarterectomy and endo vascular treatment for carotid artery stenosis : a Cochrane systemic review. Stroke 2009;40;1373-80.
67. Bonati LH, Jongen LM, Haller S et al. New ischemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICUS). Lancet Neurol 2010;9:353-62.
68. Bradley D, Creswell LL, Hogue CW Jr, et al. Pharmacologicprophylaxis: American College of Chest Physicians guide-linesfor the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest 2005;128:39-47.
69. Burgess DC, Kilborn MJ, Keech AC, et al. Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur Heart J 2006;27:2846-57.
70. Crystal E, Connolly SJ, Sliek K, et al. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: a meta-analysis. Circulation 2001;106:75-80.
71. Mitchell LB, Exner DV, Wyse DG, et al. Prophylactic Oral Amiodarone for the Prevention of Arrhythmias that Begin Early After Revascularization, valve Replacement, or Repair: PAPABEAR: a randomized control trial. JAMA 2005;294:3093-100.
72. Halonen J, Halonen P, Jarvinen O, et al. Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. JAMA 2007; 297:1562-7.
73. Prasongsukan K, Abel JG, Jamieson WR, et al. The effects of steroid on occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: a prospective randomized control trial. J Thorac Cardiovasc Surg 2005;130:93-8.
74. Lertsburapa K, White CM, Kluger J, et al. Preoperative statins for the prevention of atrial fibrillation after cardiothoracic surgery. J Thorac Cardiovasc Surg 2008; 135:405-11.
75. Patti G, Chello M, Candura D, et al. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery; results of the ARMYDA-3 (Atrovastatin for Reduction of Myocardial Dysrhythmia After cardiac surgery) study. Circulation 2006;114:1455-76.
2. Hammermeister KE, Burchfiel C, Johnson R, et al. Identification of patients at greater risk for developing major complications at cardiac surgery. Circulation 1990;82 (suppl IV):380-9.
3. Jones EL, Weintraub WS, Craver J, et al. Coronary bypass surgery: is the operation different today? J Thorac Cardiovasc Surg 1991;101;108-15.
4. Akins CW, Dagett WM, Vlahakes GJ, et al. Cardiac Operations in Patients 80 Years Old and Older. Ann Thorac Surg 1997;64:606-15.
5. Morrison D, Sartravaha K, Veerakul G. Cerebrovascular and peripheral vascular co-morbidity in High-Risk Cardiac Revascularization and Clinical Trials. Martin Dunitz 2002:373-86.
6. Khan AH, Khilji SA. Neurological outcome after coronary bypass surgery. J Ayub Med Coll Abbottabad 2005 ;17:18-21.
7. Roach GW, Kanchuger M, Mangano CM, et al. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med 1996; 335:1857-63.
8. Barbut D, Caplan LR. Brain Complications of Cardiac Surgery. Current Problems in Cardiology 1997; 22: 451-80.
9. Gardner TJ, Horneffer PJ, Manolio TA, et al. Stroke following coronary artery bypass grafting: a ten-year study. Ann Thorac Surg 1985;40:574-81.
10. Breuer AC, Furlan AJ, Hanson MR, et al. Central nervous system complications of coronary artery bypass graft surgery: prospective analysis of 421 patients. Stroke 1983; 14:682-7.
11. Newman MF, Wolman R, Kanchuger M, et al. Multicenter preoperative stroke risk index for patients undergoing coronary artery bypass graft surgery, Multicenter Study of Perioperative Ischemia (McSPI) Research Group. Circulation 1996;94(Suppl II):74-80.
12. Shaw PJ, Bates D, Cartlidge NEF, et al. Early neurological complications of coronary artery bypass surgery. Br Med J(Clin Res Ed) 1985;291:1384-7.
13. Aberg T. Effect of open-heart surgery on intellectual function. Scand J Thorac Cardiovasc Surg 1974;15:1-63.
14. Sotaniemi KA, Mononen H, Hokkeanen TE. Longterm cerebral outcome after open-heart surgery: a five-year neuropsychologic follow up study. Stroke 1986;17:410-6.
15. Shaw PJ, Bates D, Cartlidge NE, et al. Early intellectual dysfunction following bypass surgery. Q J Med 1986;58 :59-68.
16. Murkin JM, Martzke JS, Buchan AM, et al. A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary bypass surgery: Part 2: neurologic and cognitive outcomes. J Thorac Cardiovasc Surg 1995;110:349-62.
17. Venn G, Klinger L, Smith P. Neuropschychologic sequelae of bypass twelve months after coronary artery surgery. Br Heart J 1987;57:567.
18. Marzke JS, Murkin JM, Baird DL, et al. Perioperative predictors of neuropsychological outcome 3 years after coronary bypass surgery (abstract). Anesth Analg 1996; 82:SCA37.
19. McKhann GM, Seines OA, Goldsborough MA, et al. Cognitive outcomes after coronary artery bypass grafting: five-year neuropsychological followup. Ann Thorac Surg 1997;63:510-5.
20. Pompilino G, Lotto AA, Agrifoglio M, et al. Nonembolic predictors of stroke risk in coronary artery bypass patients. World J Surg 1999;23 :653-7.
21. Neville MJ, Butterworth J, James RL, et al. Similar neuro behavioral outcome after valve or coronary operations despite differing carotid embolic counts. J Thorac Cardiovasc Surg 2001;121:125-36.
22. Kadoi Y, Saito S, Fujita N et al. Risk factors for cognitive dysfunction after coronary artery bypass graft surgery in patients with type 2 diabetes. J Thorac Cardiovasc Surg 2005;129:576-83.
23. Wareing TH, Davila-Roman VG, Barzilai B, et al. Management of the severely atherosclertic ascending aorta during cardiac operations. J Thorac Cardiovasc Surg 1992;103:453-62.
24. Wareing TH, Davila-Roman VG, Daily BB, et al. Strategy for the reduction of stroke incidence in cardiac surgical patients. Ann Thorac Surg 1993;55:1400-8.
25. Bar-El Y, Goor DA. Clamping of the atherosclerotic ascending aorta during coronary bypass operations: its cost in strokes. J. Thorac Cardiovasc Surg 1992; 104:469-74.
26. Davila-Roman VG, Barzilai B, Wareing TH, et al. Atherosclerosis of the ascending aorta: Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. Stroke 1994;25:2010-6.
27. Bolotin G, Domany Y, de Perini L, et al. Use of Intraoperative Epiaortic Ultrasoundsonography To Delineate Aortic Ath eroma. Chest 2005;127:60-5.
28. Fayad ZA, Nahaer T, Fallon JT, et al. In vivo magnetic resonance evaluation of atherosclerotic plaques in the human thoracic aorta: a comparison with transesophageal echocardiography. Circulation 2000;101:2503-9.
29. Barbut D, Yao FS, Hagger DN, et al. Comparison of Transcranial Doppler Ultrasonography and Transesophageal Echocardiography to monitor Emboli During Coronary Artery Bypass Surgery. Stroke 1996;27:87-90.
30. Barbut D, Yao FS, Lo YW, et al. Determination of size of aortic emboli and embolic load during coronary artery bypass grafting. Ann Thorac Surg 1997;63:1262-7.
31. Schwartz LB, Bridgman AH, Keiffer RW, et al. Asymptomatic C arotid Artery Stenosis and stroke in patients undergoing cardiopulmonary bypass. J Vas Surg 1995;21:146-53.
32. Clark RE, Brillman J, Davis DA, et al. Microemboli during coronary artery bypass grafting: genesis and effect on outcome. J Thorac Cardiovasc Surg 1995;109:249-58.
33. Pugsley W, Klinger L, Paschalis C, et al. The impact of microemboli during cardiopulmonary bypass on neuro psychologic functioning. Stroke 1994;25:1393-9.
34. Wolman RL, Kanchuger MS, Newman MF, et al. Adverse neurologic outcome following cardiac surgery. Anesth Analg 1994;78:484.
35. Barbut D, Hinton RB, Szatrowski TP, et al. Cerebral emboli detected during bypass surgery are associated with clamp removal. Stroke 1994;25:2398-402.
36. Frost L, Molgaad H, Christiansen EH, et al. Atrial fibrillation and flutter after coronary bypass surgery: epidemiology, risk factors, and preventive trials. Int J Cardiol 1992;36:253-61.
37. Cox JL. A Perspective of Postoperative Atrial Fibrillation in Cardiac Operations. Ann Thorac Surg 1993;56:405-9.
38. Almassi GH, Schowalter T, Nicolosi AC, et al. Atrial Fibrillation After Cardiac Surgery. Ann Surg 1997; 226:501-13.
39. Ngaage DL, Schaff HV, Mullany CJ, et al. Does preoperativeatrial fibrillation influence early and late outcomes of coronary artery bypass grafting? J Thorac cardiovasc Surg 2007;133:182-9.
40. Mariscalco G, Klersy C, Zanobini M, et al. Atrial f ibrillation after isolated coronary surgery affects late survival. Circulation 2008;118:1612-8.
41. Aijns W, Kolh P, Danchin N, et al. Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Hear J 2010;31: 2501-5.
42. Salasidis, GC, Latter, DA, Steinmetz, OK, et al. Carotid artery duplex scanning in preoperative assessment for coronary artery revascularization: the association between peripheral vascular disease, carotid artery stenosis, and stroke. J Vasc Surg 1995;21:154-60.
43. Oka Y, Inoue T, Hong Y, Sisto DA, et al. Retained intracardiac air: transesophageal echocardiography for definition of incidence and monitoring by improved techniques. J Thorac Cardiovasc Surg 1986;91:329-38.
44. Topol EJ, Humphrey LS, Borkon M, et al. Value of intraoperative left ventricular microbubbles detected by tranesophageal two-dimensional echocardiopgraphy in predicting neurologic outcome after cardiac operations. Am J Cardiol 1985;56:773-5.
45. Tufo HM, Osffeld AM, Shekelle R. Central nervous system dysfunction following open-heart surgery. JAMA 1970; 212:1333-40.
46. Gold JP, Charlson ME, Williams-Russo P, et al. Improvement of outcome after coronary artery bypass: a randomized trial comparing intraoperative high vs low mean arterial pressure. J Thorac Cardiovasc Surg 1995; 110:1302-14.
47. Benetti FJ, Mariani MA, Sani G, et al. Video assisted mini-invasive coronary surgery without cardiopulmonary bypass: a multicenter study. J Thorac Cardiovasc Surg 1996;112:1478-84.
48. Lytle BW, Sabik JF. On-Pump and Off-Pump Bypass Surgery, Tool for revascularization. Circulation 2004; 109:810-2.
49. Arom KV, Flavin TF, Emery RW, et al. Safety and efficacy of offpump coronary bypass grafting. Ann Thorac Surg 2000;69:704-10.
50. Cleveland J, Shroyer A LW, Chen A Y, et al. Off-pump coronary bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 2001;72:1282-9.
51. Hannan EL, Wu C, Smith CR, et al. Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery: Differences in Short-term Outcomes and in Long-term Mortality and Need for Subsequent Revascularization. Circulation 2007;116:1145-52.
52. Van Dijk D, Nierich AP, Jansen EWL, et al. Early outcome after off-pump versus on-pump coronary bypass surgery: Results from a randomized study. Circulation 2001:104:1761-6.
53. Angelini GD, Taylor FC, Reeves BC, et al. Early and midterm outcome after off-pump and on-pump surgery in beatingheart against cardioplegic arrest studies (BHACAS 1 and 2); a pooled analysis of two randomized controlled trials. Lancet 2002;359:1194-9.
54. Shroyer AL, Grover FL, Hattler B, et al. for the VA Randomized On/Off Bypass (ROOBY) Study Group. On-Pump versus Off-Pump Coronary- Artery Bypass Surgery 2009:361(9);1827-37.
55. Morris CD, Eagle K, O’Rourke RA, et al. Coronary Artery Bypass Graft Surgery. In: V Fuster editor. The AHA Guidelines and Scientific Statements Handbook. American Heart Association, Wiley-Blackwell 2009:134-51.
56. King SB , Lembo NJ, Weintraub WS, et al. A randomized trial comparing coronary angioplasty with coronary bypass surgery: Emory Angioplasty Versus Surgery Trail (EAST): N Engl J Med 1994;331:1044-50.
57. Kosinski As, Barnhart HX, Weintraub WS, et al. Five year outcome after coronary angioplasty or coronary surgery: result from the Emory Angioplasty Versus Surgery Trail (EAST) : Circulation 1995;91(suppl I):543.
58. Scott J Hoffman SJ, Holmes DR Jr, Rabinstein AA, et al. Trends, Predictors and Outcomes of Cerebrovascular Events Related to Percutaneous Coronary Intervention. J Am Coll Cardiol Intv 2011;4:415-22.
59. Hlatsky MA, Boothroyd DB, Bravata DM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease : a collaborative analysis of individual patient data from ten randomized trials. Lancet 2009;373:1190-7.
60. Aziz O, Rao C, Panesar SS, et al. Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery. BMJ 2007;334:617.
61. Kapoor JR, Gienger AL, Ardehali R, et al. Isolated disease of the proximal left anterior descending artery comparing the effectiveness of percutaneous coronary interventions and coronary artery bypass surgery. JACC Cardiovasc Interv 2008;1:483-91.
62. Holzhey DM, Jacobs S, Mochalski M, et al. Minimally invasive hybrid coronary artery revascularization. Ann Thorac Surg 2008;86:1856-60.
63. Kon ZN, Brown EN, Tran R, et al. Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared from conventional offpump coronary bypass. J Thorac Cardiovasc Surg 2008;135:367-75.
64. Ederle J, Dobson J, Featherstone RL, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomized controlled trial. Lancet 2010;375:985-97.
65. Brott TG, Hobson RW, Howard G, et al. Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis. N Engl J Med 2010;363:11-23.
66. Ederle J, Featherstone RL, Brown MM. Randomized controlled trials comparing endarterectomy and endo vascular treatment for carotid artery stenosis : a Cochrane systemic review. Stroke 2009;40;1373-80.
67. Bonati LH, Jongen LM, Haller S et al. New ischemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICUS). Lancet Neurol 2010;9:353-62.
68. Bradley D, Creswell LL, Hogue CW Jr, et al. Pharmacologicprophylaxis: American College of Chest Physicians guide-linesfor the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest 2005;128:39-47.
69. Burgess DC, Kilborn MJ, Keech AC, et al. Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur Heart J 2006;27:2846-57.
70. Crystal E, Connolly SJ, Sliek K, et al. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: a meta-analysis. Circulation 2001;106:75-80.
71. Mitchell LB, Exner DV, Wyse DG, et al. Prophylactic Oral Amiodarone for the Prevention of Arrhythmias that Begin Early After Revascularization, valve Replacement, or Repair: PAPABEAR: a randomized control trial. JAMA 2005;294:3093-100.
72. Halonen J, Halonen P, Jarvinen O, et al. Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. JAMA 2007; 297:1562-7.
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