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The Annals of Thoracic Surgery, Vol 36, 427-432, Copyright © 1983 by The Society of Thoracic Surgeons
RM Bojar, H Najafi, GA DeLaria, C Serry and MD Goldin
In a series of 3,206 consecutive coronary artery bypass procedures
performed between 1976 and 1981, 89 patients died (2.8% mortality) and 32
patients (1%) suffered major neurological syndromes. Among the latter
patients, four distinct groups were identified. Group 1 consisted of 10
patients who remained unresponsive after operation. In Group 2 were 10
patients who awakened after operation but had clinical evidence of focal
cerebral infarction. Group 3 included 6 patients who were initially intact
neurologically but in whom neurological deficits later developed. In Group
4 were 6 patients who had severe mental aberration but no focal
neurological deficits. The incidence of coma or focal deficit occurring
without a lucid interval (Groups 1 and 2) was 0.62%, and these patients had
a 30% mortality. Causative factors were suspected in 70% of the patients in
Groups 1 and 2, and included atheromatous embolism, perioperative
hypotension, carotid artery occlusive disease and air embolism. The outcome
was poor for unresponsive patients, with 70% dying or remaining comatose,
but nearly all of the patients with focal deficits or severe mental
aberration demonstrated notable improvement.
ARTICLES
Neurological complications of coronary revascularization
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