Is there a relationship between cognitive dysfunction and systemic inflammatory response after cardiopulmonary bypass?

Westaby, Stephen; Saatvedt, Kjell; White, Sno E.; Katsumata, Takahiro; Oeveren, van Willem; Halligan, PW

doi:10.1016/s0003-4975(00)02405-x

Cited by 58 publications

(32 citation statements)

References 19 publications

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“…Affection of cerebral perfusion and alteration of cognitive performance are known sequelae of SIRS and can cause early CD. 30 In this cohort, we found no significant association of nonembolic hemodynamic deterioration and CD.…”

Section: Procedural Complicationscontrasting

confidence: 51%

Cognitive Trajectory After Transcatheter Aortic Valve Implantation

Ghanem

Kocurek

Sinning

et al. 2013

Circ: Cardiovascular Interventions

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Background-Transcatheter aortic valve implantation (TAVI) is known to be associated with silent cerebral injury, which could contribute to cognitive impairment. Considering its increasing use, thorough longitudinal investigation of cognitive trajectory after TAVI is pivotal. Methods and Results-Repeatable battery for the assessment of neuropsychological status was performed before (E1), 3 days (E2), 3 months (E3), 1 (E4) year, and 2 years (E5) after TAVI. Baseline characteristics, procedural data, imaging parameters of brain injury (diffusion-weighted MRI), and the use of conceivable neuroprotective approaches were investigated for their effect on cognitive function. Cognitive performance was investigated in 111 patients (mean log EuroSCORE, 30±13%). Global cognitive function (repeatable battery for the assessment of neuropsychological status total score) increased transiently at E2 (P=0.02) and was comparable with baseline levels at E3, E4, and E5. Six patients (5.4%) demonstrated early cognitive decline. Persistence and late onset were seen infrequently (n=3, 2.7% and n=4, 3.6%, respectively). Hence, early cognitive decline was ruled out in 105 patients (94.6%), and a majority of patients (91%) demonstrated sustained cognitive performance throughout all investigated time points. Interestingly, only patient age (P=0.012), but not prior cerebrovascular events, cognitive status, direct TAVI, cerebral embolism in diffusion-weighted MRI, or the use of a cerebral embolic protection device was found to be independently associated with cognitive decline, linking higher age to cognitive impairment along the first 2 years after TAVI. Conclusions-Long-term cognitive performance was preserved in the great majority (91%) of patients throughout the first 2 years after TAVI, despite the high intrinsic risk for cognitive deterioration. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00883285.(Circ Cardiovasc Interv. 2013;6:615-624.)Key Words: cognition ◼ dementia ◼ injury ◼ intracranial embolism ◼ mild cognitive impairment ◼ stroke ◼ TAVR

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Section: Procedural Complicationscontrasting

confidence: 51%

Cognitive Trajectory After Transcatheter Aortic Valve Implantation

Ghanem

Kocurek

Sinning

et al. 2013

Circ: Cardiovascular Interventions

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“…A significant reduction in both the micro-embolism rate and neuropsychological decline has been demonstrated by the use of filters in the CPB circuit [22]. In fact, with the advances in extracorporeal circulation technology and manufacturing, recent studies have failed to detect significant cognitive function decline following open heart surgery [23,24].…”

Section: Discussionmentioning

confidence: 99%

Cerebral functions and metabolism after antegrade selective cerebral perfusion in aortic arch surgery

Pacini

Marco

Leone

et al. 2010

European Journal of Cardio-Thoracic Surgery

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There was no evidence of ischaemic brain injury after ASCP even if some degree of reversible brain oedema secondary to cardiopulmonary bypass (CPB) was present. The cognitive outcomes in patients undergoing ASCP were comparable to patients undergoing coronary artery bypass. The lack of left subclavian artery perfusion during cerebral perfusion leads to temporary glucose hypometabolism in the occipital lobes without neuronal injury.

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“…5,6,12 Postoperative stroke risk is 25% 29 when mobile atheroma plaques appear, 8% when the plaque is fixed, or 1.8% if there is no plaque. 41,42 Solid microemboli are probably the most damaging and they increase 2-fold in on pump versus off-pump procedures. Cerebral microembolization is significantly reduced with avoidance of CPB.…”

Section: Cardiopulmonary Bypass: General Commentsmentioning

confidence: 99%

Neurological Damage Related to Cardiac Surgery

Carrascal¹,

Peral²

2010

The Neurologist

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Even in milder cases, neurologic complications related to cardiac surgery increase mortality, hospitalization time, and rehabilitation costs, and so contribute to the decrease in quality of life. The incidence of neurologic complications has remained unchanged during the last years, despite age and comorbidity increasing. Improvement in technical approaches has probably contributed to maintain these percentages. Although most of the complications may be related to cardiopulmonary bypass, others factors are also involved. Identifying high risk patients could reduce incidence of complications within high risk groups, but this is probably an insufficient preventive strategy. In a population progressively older and presumably affected by an increasing number of diseases, preventive strategies should be focused on 3 aspects: first, technical improvements in cardiac surgery and cerebral protection; second, pharmacologic therapy; and, finally, identification of reliable techniques to evaluate neuropsychological dysfunction after cardiac surgery. Future efforts will be necessary to identify surrogate markers of neurologic damage and its functional outcome, perhaps related to genetic susceptibility.Only with all of these instruments, really effective preventive or palliative strategies could be planned and applied.

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Is there a relationship between cognitive dysfunction and systemic inflammatory response after cardiopulmonary bypass?

Cited by 58 publications

References 19 publications

Cognitive Trajectory After Transcatheter Aortic Valve Implantation

Cognitive Trajectory After Transcatheter Aortic Valve Implantation

Cerebral functions and metabolism after antegrade selective cerebral perfusion in aortic arch surgery

Neurological Damage Related to Cardiac Surgery

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