Long-term cerebral outcome after open-heart surgery. A five-year neuropsychological follow-up study.

Abstract

SUMMARY A prospective 5 years' neuropsychological, neurological, cardiological and electroencephalographkal follow-up study was carried out in 44 patients who had undergone open-heart surgery for valve replacement. A distinct interrelationship was found between the clinical outcome immediately after operation and the neuropsychological long-term course despite the rapid recovery of occasional clinical disorders related to operative procedures. In fact, the psychometric performance scores of those who did not develop clinical signs of cerebral dysfunction induced in operation showed a significant difference only years after operation. Similarly, the harmful effects of long perfusion time (ertracorporeal circulation) in operation were reflected in the long-term neuropsychological performance. Some evidence seemed to suggest that the correction of the prolonged circulatory disorder might possibly afford real enhancement of higher cerebral functions. The long-term results not only emphasize the importance of a careful clinical evaluation but also emphasize the necessity of considering the subclinteal level of events both before and after operation when assessing the overall outcome and cerebral safety of cardiac surgery patients.Stroke Vol 17, No 3, 1986CENTRAL NERVOUS SYSTEM (CNS) dysfunction has occasionally cast a shadow over the results of cardiac surgery. The development of surgical and anaesthesiological equipment has notably improved cerebral safety, and the occurrence of severe complications has become rare.'" 4 The well-being of the CNS, however, has not become self-evident and secure because several potentially harmful factors always remain in such complicated procedures as open-heart operations. It must also be emphasized that when only clinical criteria have been used to evaluate the CNS outcome, the appraisal of the results seems to have been too optimistic. 43 Clinical measures have been shown to provide only a narrow view over the actual CNS events, for the involvement of the subclinical levels has been revealed in electroencephalographical (EEG), 6 " 10 neuropsychological,"" 18 psychiatric 19 and radiological 20 studies.Previous studies investigating the long-term outcome of open-heart operations have concentrated their attention on cardiological and surgical aspects. "29 By contrast, the outcome of the higher cerebral functions has been given little attention, the earlier investigations having focused on describing the prevalence, nature and determinants of immediate postoperative disturbances using follow-up times limited to a few weeks or months."' l3 ' 16 Frank et al 16 performed a 6 months' study after operation and reported improvement in all the measured areas of intellectual performance. Preoperative anxiety seemed to worsen the improvement, probably by rendering the patients less apt to recall the test items. The intellectual changes were independent of cardiac functional measures. It was concluded that the observed improvement was only due to practice effects and that improved cerebral perf...

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