This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. In the United States, approximately 650,000 patients undergo coronary artery bypass grafting (CABG) each year. This procedure is extremely successful at relieving the symptoms of coronary disease. However, CABG is associated with a variety of neurological problems, ranging from stroke to cognitive changes and depression, and these remain major causes of poor outcomes after heart surgery. Cognitive decline from 2 weeks to 2 months after CABG has been estimated to occur in 30% to 79% of patients. Additionally, the possibility that CABG patients may have cognitive problems that extend to 1 or more years after surgery, has not been extensively investigated. The cause of these neurological problems is uncertain but may be related to events that occur during the procedure. This study will compare cognitive outcomes in four groups: patients having conventional CABG; patients having off-pump CABG (OPCAB), a procedure performed on the beating heart, without the use of the cardiopulmonary bypass machine; patients who have diagnosed coronary disease, but have been managed medically, and patients without coronary artery disease or risk factors for the disease. Patients are evaluated with neuropsychological tests and measures of depression at four time points: preoperatively/baseline: and, at 3 months, and 1, 3, and 5 years. The objective of this proposal is to determine the role of the cardiopulmonary bypass machine in cognitive change after CABG with the ultimate purpose of proposing interventions to overcome these adverse effects if they exist.
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