Neuropsychological outcomes of coronary artery bypass grafting: research

Abstract

People with coronary heart disease have recourse to a palliative intervention such as Coronary Artery Bypass Grafting (CABG). There is increasing recognition, however, that postoperative cerebral complications and neuropsychological decline constitute a significant proportion of adverse outcomes associated with the CABG procedure. Utilising a one-group pre- and posttest quasi-experimental design, nineteen participants undergoing elective CABG at the Pretoria Academic Hospital, were assessed on a neuropsychological test battery comprising six instruments and the Beck Depression Inventory. The main aim of the study was to investigate the neuropsychological outcomes in CABG patients after elective surgery. The secondary aim was to determine if neuropsychological outcomes correlate with quantitative electroencephalography (QEEG). The findings indicated that postoperatively, 63% of patients demonstrated cognitive change in various neuropsychological domains. A group mean analysis found significant postoperative decline on specific tasks of the Grooved Pegboard Test (GPT), the Rey Auditory Verbal Learning Test (RAVLT), and the Trail Making Test (TMT). The relationship between neuropsychological performance and the QEEG measures was not significant. The study confirms previous findings regarding selective neuropsychological postoperative performance decrement, and highlights the importance of psychological intervention in the rehabilitation process.


Key words: Neuropsychological assessment; Cognitive domains; Coronary artery bypass grafting; Deficit measurement; Rehabilitation


OPSOMMING

Persone met ‘n koronêre hartsiekte is soms genoodsaak om ‘n hartomleiding (CABG), wat ‘n tydelike intervensie ter verligting is, te ondergaan. Daar is egter ‘n toenemende bewustheid dat die serebrale komplikasies en afname in neurosielkundige funksies, wat met die CABG-prosedure verband hou, betekenisvolle ongunstige uitkomste na die chirurgie het. ‘n Neurosielkundige toetsbattery, wat uit ses instrumente bestaan, en die “Beck Depression Inventory”, is gebruik om die neurosielkundige uitkomste by negentien persone te ondersoek wat elektiewe hartomleidingchirurgie by die Pretoria Akademiese Hospitaal ondergaan het. Verder is ook gepoog om vas te stel of neurosielkundige uitkomste met kwantitatiewe elektroënsefalografie (KEEG) korreleer. In hierdie studie is ‘n eengroep voor- en natoets kwasi-eksperimentele ontwerp gebruik. Daar is bevind dat 63% van die pasiënte wel kognitiewe verandering in verskeie neurosielkundige domeine ondergaan het. ‘n Groepgemiddelde ontleding het betekenisvolle agteruitgang op spesifieke take van die “Grooved Pegboard Test (GPT)”, die “Rey Auditory Verbal Learning Test (RAVLT)”, en die “Trail Making Test (TMT)” na die chirurgie bevind. Die verhouding tussen neurosielkundige prestasie en die KEEG-meting was nie betekenisvol nie. Die navorsing bevestig vorige bevindings met betrekking tot die agteruitgang in prestasie na die CABG-prosedure en beklemtoon die belangrikheid van sielkundige intervensie in die rehabilitasieproses.



Health SA Gesondheid Vol.9(3) 2004: 3-14