Clinical Faculty

Mark F. Newman, MD

Merel H. Harmel Professor of Anesthesiology in the School of Medicine, Professor of Medicine

Chair, Department of Anesthesiology
Merel H. Harmel Professor

Department:
Anesthesiology

Division:
Anesthesiology

Mailing Address:
DUMC 3094 Durham, NC 27710

Appointment Telephone:
919-681-6646

Office Telephone:
919-681-6646

Fax:
919-681-2923

Training:
MD, University of Louisville School of Medicine (Kentucky), 1985

Fellowship:
Cardiac Anesthesiology and Transesophageal Echocardiography, Duke University Medical Center, 1988-1989

Residency:
Anesthesiology, Wilford Hall Medical Center (Texas), 1986-1988

Clinical Interests:
General anesthesiology, cardiothoracic anesthesiology, perioperative neuroprotection, perioperative clinical trials, perioperative organ protection, perioperative cognitive decline

Research Interests:
Cognitive decline is now recognized as a significant complication among patients who undergo cardiac surgery, being evident in as many as three quarters of patients at the time of discharge from the hospital and one-third after six months.  Our research has confirmed the relatively high prevalence and persistence of cognitive decline after coronary artery bypass surgery (CABS).  Our data suggest a pattern of early improvement followed by a later decline that is predicted by the presence of early postoperative cognitive decline.  Much of our research focuses on identifying significant predictor variables that may enable physicians to better screen for and counsel patients who may be at high risk for persistent cognitive decline.  Recently, we evaluated the association of Apolipoprotein E e-4 and postoperative cognitive dysfunction and found that there is a significant association, a finding we had anticipated because of the similar pattern of cognitive decline seen in patients with early Alzheimer's disease.  We are also investigating the effects of temperature on a variety of postoperative indices of psychological functioning and quality of life.  In one study, we compared two groups of patients on a number of physical, social, and psychologic measures prior to and again at six weeks and six months after surgery.  The results of this study indicate that hypothermic conditions during surgery are associated with higher levels of emotional distress after CABS than are normothermic conditions, particularly for patients with higher levels of stress before surgery.  Our group is also exploring the neurocognitive decline that is often produced by atherosclerotic plaque embolization during cardiopulmonary bypass (CPB).  We found that a link exists between the P1A2 allele of platelet GPIIIa and neurocognitive decline early after CPB, suggesting that the P1A2 polymorphism may exacerbate pre-existing vascular pathologies.  Future studies will hopefully confirm this association and determine whether the presence of P1A2 predicts a higher incidence of neurocognitive deficits.  In addition to investigating predictors of postoperative cognitive decline, we are also carrying out longitudinal studies to determine the association between decline in cognitive functioning and changes in quality of life following surgery. To date, we have shown that there is a strong relationship between neurocognitive functioning and quality of life as long as five years after surgery.  Ten-year follow-up studies are currently underway.

Publications:
Savino JS, Ley C, Boisvert D, Friedman A, Mathew J, Koch C, Starr N, Mora-Mangano C, Herskowitz A, Browner WS, Mangano DT for the Multicenter Study of Peroperative Ischemia (McSPI) Research Group and the Ischemia Research and Education Foundation (IREF).  Transesophageal echocardiography interpretation:  a comparative analysis between cardiac anesthesiologists and primary echocardiographers.  Cardiothorac Vasc Anesth, 16: 1072-78, 2002.

Tardiff BE, Newman MF, Saunders AM, Strittmatter WJ, White W, Blumenthal JA, Croughwell ND, Smith LR, Davis RD, Roses AD, Reves JG, The Neurologic Outcome Research Group of the Duke Heart Center. Preliminary report of a genetic basis for cognitive decline after cardiac operations. Ann Thorac Surg 64:715-720, 1997.

Roach GW, Kanchurger M, Mora Mangano C, Newman MF, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham SH, Ley C, Ozanne G, Mangano DT, for the Multicenter Study of Periperative Ischemia (McSPI) Research Group and the Ischemia Research and Education Foundation Investigators: Adverse cerebral outcomes after coronary bypass surgery. The New England J Medicine 335:1857-63, 1996.

Newman MF, Wolman R, Kanchuger M, Marschall K, Mora-Mangano C, Roach G, Smith LR, Aggarwal A, Nussmeier N, Herskowitz A, Mangano DT, and Participants in the Multicenter Study of Periperative Ischemia (McSPI) Research Group:  Multicenter preoperative stroke risk index for patients undergoing coronary artery bypass surgery.  Circulation 94:II74-80, 1996.

Newman MF, Croughwell ND, White WD, Lowry E, Balkwin BI, Clements FM, Davis RD, Jones RH, Amory DW, Reves JG: Effect of perfusion pressure on cerebral blood flow during normothermic pardiopulmonary bypass. Circulation 94[Suppl II}: II-353-7, 1996.