Encephalopathy and Stroke After Coronary Artery Bypass Grafting.

Both 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 indicate the degree of cerebrovascular disease. At present we do not have this information on most patients. 2) The status of arteriosclerotic disease of the aorta should be determined prior to surgery or at the time of surgery. 3) For those with significant aortic and cerebrovascular disease, alternatives to the conventional ways of performing coronary artery bypass grafting (CABG) should be considered. These alternatives include percutaneous transluminal coronary angioplasty, off-pump surgery, and CABG using filters or inputs from the pump that selectively protect the brain.