Richard M Royall

BACKGROUND: Cognitive impairment after coronary artery bypass grafting (CABG) is well recognized, but previous investigations have been limited by lack of an appropriate control group. We compared changes in cognitive performance at 3 and 12 months after CABG with those in a control group of patients with comparable risk factors for coronary artery disease (CAD) who had not undergone surgery.

METHODS: Patients undergoing CABG (n = 140) and demographically similar nonsurgical control ...

OBJECTIVE: To determine the long-term (preoperative to 5 years postoperative) and late (1-5 years postoperative) changes in cognitive test performance in patients after coronary artery bypass grafting.

SETTING: The departments of surgery and neurology at The Johns Hopkins University School of Medicine, Baltimore, Md.

PATIENTS: A group of 102 patients who completed preoperative and follow-up cognitive testing up to 5 years after coronary artery bypass grafting.

MAIN OUTCOME MEASURES: A ...

BACKGROUND: In contrast to perioperative stroke, much less attention has been paid to those with evidence of diffuse brain encephalopathy, presenting as delirium, confusion, coma, and seizures in the immediate postoperative period.

OBJECTIVE: To determine the incidence, consequences, and predictive factors for encephalopathy and stroke following coronary artery bypass grafting.

METHODS: In a prospective evaluation of 2711 patients operated on between January 1, 1997, and December 31, ...

The purpose of this study was to determine whether depression 1 month after coronary artery bypass surgery would be associated with greater cardiac morbidity in patients 5 years later. The cardiac symptom most affected by depression was the recurrence of angina. Factors associated with a return of angina at 5 years were depression measured preoperatively, at 1 month, at 1 year, and at 5 years. Additional significant factors were male sex and a preoperative history of smoking, ...

Opinion statementBoth stroke and encephalopathy are associated with significantly longer lengths of stay in the hospital and with significantly higher rates of mortality. Those at risk for either stroke or encephalopathy, or both of these adverse outcomes after surgery, can be identified prior to surgery using information available to physicians. For those at higher risk for these outcomes, we suggest the following: 1) An imaging study of the brain, performed prior to surgery, may ...