Cognitive function after open-heart surgery: Are postoperative neuropsychological deficits caused by cardiopulmonary bypass?

Despite the many technological developments in arterial perfusion and cardiac surgical procedures, open-heart surgery is still believed to pose a significant risk for cerebral injury. There are several potential causes of brain damage during open-heart surgery, including prolonged or severe arterial hypotension, as well as emboli emanating from the cardiopulmonary bypass circuit or the operative field. This article reviews the available neuropsychological studies of outcome following cardiac valve replacement and coronary artery bypass grafting. Because both procedures are life-saving operations, the research in this area has been quasi-experimental and fraught with methodological problems. Nonetheless, the findings converge to suggest that cognitive dysfunction occurs after open-heart surgery, and that the deficits are attributable, at least in part, to factors specific to the operation or to the patient being maintained on cardiopulmonary bypass. Preliminary findings suggest that embolization is the primary cause of perioperative deficits in uncomplicated operations. Studies have also consistently found preoperative deficits in this population, suggesting that neuropsychological dysfunction is caused by severe chronic cardiac disease as well as open-heart surgery.     

Attentional misguidance in visual search

Previous research has shown that a task-irrelevant sudden onset of an object will capture an observer’s visual attention or draw it to that object (e.g., Yantis & Jonides, 1984). However, further research has demonstrated the apparent inability of an object with a task-irrelevant but unique color or luminance to capture attention (Jonides & Yantis, 1988). In the experiments reported here, we reexplore the question of whether task-irrelevant properties other than sudden onset may capture attention. Our results suggest that uniquely colored or luminous objects, as well as salient though irrelevant boundaries, do not appear to capture attention. However, these irrelevant features do appear to serve as landmarks for a top-down search strategy which becomes increasingly likely with larger display set sizes. These findings are described in terms of stimulus-driven and goal-directed aspects of attentional control.