Can Cognition Survive Heart Surgery?

Samuels, Martin A.

doi:10.1161/circulationaha.106.632711

Cited by 10 publications

(2 citation statements)

References 14 publications

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“…In a subgroup of patients, preexisting cognitive deficit caused by cerebral vascular disease may be aggravated by embolism or hypoperfusion during cardiac surgery. After primary recovery, these patients may later show a progressive cognitive decline independently from the cardiac surgery [19,25]. …”

Section: Discussionmentioning

confidence: 99%

Postoperative cognitive deficit after cardiopulmonary bypass with preserved cerebral oxygenation: a prospective observational pilot study

et al. 2011

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BackgroundNeurologic deficits after cardiac surgery are common complications. Aim of this prospective observational pilot study was to investigate the incidence of postoperative cognitive deficit (POCD) after cardiac surgery, provided that relevant decrease of cerebral oxygen saturation (cSO2) is avoided during cardiopulmonary bypass.MethodscSO2 was measured by near infrared spectroscopy in 35 patients during cardiopulmonary bypass. cSO2 was kept above 80% of baseline and above 55% during anesthesia including cardiopulmonary bypass. POCD was tested by trail making test, digit symbol substitution test, Ray's auditorial verbal learning test, digit span test and verbal fluency test the day before and 5 days after surgery. POCD was defined as a decline in test performance that exceeded - 20% from baseline in two tests or more. Correlation of POCD with lowest cSO2 and cSO2 - threshold were determined explorative.ResultsPOCD was observed in 43% of patients. Lowest cSO2 during cardiopulmonary bypass was significantly correlated with POCD (p = 0.015, r2 = 0.44, without Bonferroni correction). A threshold of 65% for cSO2 was able to predict POCD with a sensitivity of 86.7% and a specificity of 65.0% (p = 0.03, without Bonferroni correction).ConclusionsDespite a relevant decrease of cerebral oxygen saturation was avoided in our pilot study during cardiopulmonary bypass, incidence of POCD was comparable to that reported in patients without monitoring. A higher threshold for cSO2 may be needed to reduce the incidence of POCD.

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Section: Discussionmentioning

confidence: 99%

Postoperative cognitive deficit after cardiopulmonary bypass with preserved cerebral oxygenation: a prospective observational pilot study

et al. 2011

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“…These results suggest that cognitive impairment in HF patients is closely related to cerebral perfusion measures. Additionally, there are multiple studies examining the effects of reduced cerebral perfusion, as measured using Doppler imaging, on cognitive decline [70][71][72]. Moreover, Zuccala et al found a linear relationship between MMSE scores and left ventricular ejection fractions lower than 40% [73].…”

Section: Pathogenesis Of CI In Hfmentioning

confidence: 99%

The Importance of Longitudinal Neurocognitive Assessments in Heart Failure Patients Receiving a Left Ventricular Assist Device

Raju

Rojas-Luengas

2015

UOJM

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ABSTRACT:Heart failure (HF) is a major global health concern that has continued to increase in incidence and prevalence, becoming a global epidemic. In Canada alone, there are 500,000 HF patients, with 50,000 new cases each year. Often, HF patients reach severe end stage HF (ESHF) and require a heart transplant or a left ventricular assist device (LVAD). Previous studies have shown that as the heart begins to fail, ESHF patients develop a global cognitive impairment (CI) that accompanies the reduction in blood pressure (BP) and cardiac output (CO). Several mechanisms have been attributed to the CI observed in ESHF patients. Cerebral hypoperfusion, due to a large decrease in CO, appears to be the most supported explanation. Although several studies to date have explored cognitive functioning after the treatment of HF, there is limited literature investigating the cognitive outcome in ESHF patients following LVAD implantation. Moreover, studies that examined the effect of LVAD implantation on cognition did not compare patient outcomes to pre-LVAD baseline levels. Taking into consideration the increasing number of EDHF patients in need of LVAD implantation each year, it is imperative to determine the effect of this intervention on CI in order to better inform LVAD patients and create effective rehabilitation programs for LVAD recipients.RÉSUMÉ:L’insuffisance cardiaque (IC) est une préoccupation majeure de santé mondiale qui continue d’augmenter en incidence et en prévalence, devenant une épidémie mondiale. Au Canada seulement, 500 000 patients souffrent d’IC, avec 50 000 nouveaux cas chaque année. Souvent, les patients avec IC atteignent une phase terminale grave (ICT) et nécessitent une transplantation cardiaque ou un dispositif d’assistance ventriculaire gauche (DAVG). Des études antérieures ont démontré que lorsque le cœur est en insuffisance, les patients développent une déficience cognitive globale (DCG), accompagnant la réduction de la tension artérielle et du débit cardiaque. Plusieurs mécanismes ont été attribués à la DCG observée chez les patients en ICT. L’hypoperfusion cérébrale, en raison d’une diminution importante du débit cardiaque, semble être l’explication la plus soutenue. Bien que plusieurs études à ce jour ont exploré le fonctionnement cognitif suivant le traitement de l’IC, il existe une littérature limitée enquêtant le résultat cognitif chez les patients en ICT suivant l’implantation d’un DAVG. Par ailleurs, les études qui ont examiné l’effet de l’implantation de DAVG sur la cognition ne comparaient pas les résultats des patients avec leurs niveaux de base pré-DAVG. Prenant en considération le nombre croissant de patients en ICT en besoin d’implantation de DAVG chaque année, il est impératif de déterminer l’effet de cette intervention sur la DCG afin de mieux informer les patients avec DAVG et créer des programmes efficaces de réhabilitation pour les bénéficiaires de DAVG.

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Neurologische Komplikationen nach herzchirurgischen Operationen

Dittrich

Ringelstein

2011

Z Herz- Thorax- Gefäßchir

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Can Cognition Survive Heart Surgery?

Cited by 10 publications

References 14 publications

Postoperative cognitive deficit after cardiopulmonary bypass with preserved cerebral oxygenation: a prospective observational pilot study

Postoperative cognitive deficit after cardiopulmonary bypass with preserved cerebral oxygenation: a prospective observational pilot study

The Importance of Longitudinal Neurocognitive Assessments in Heart Failure Patients Receiving a Left Ventricular Assist Device

Neurologische Komplikationen nach herzchirurgischen Operationen

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