Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 1: The problem; nomenclature; delirium and postoperative neurocognitive disorder; and the role of cardiac surgery and anesthesia

Kapoor, Mukul Chandra

doi:10.4103/aca.aca_138_19

Cited by 15 publications

(11 citation statements)

References 72 publications

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“…In our study, the incidence of new PND within 7 days after surgery was 33.33%. These statistics, despite being higher than the incidence rate after noncardiac surgery, are consistent with other research in cardiac surgery ( 14 ).…”

Section: Discussionsupporting

confidence: 92%

NLRP3 inflammasome activation contributes to the cognitive decline after cardiac surgery

Sun

Chen

et al. 2022

Front. Surg.

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BackgroundPerioperative neurocognitive disorders (PND) are a common complication of cardiac surgery in elderly patients. The etiopathogenesis of PND is not clear. Nod-like receptor family pyrin domain containing 3 (NLRP3) inflammasome, a macromolecular protein complex, regulates inflammation by inducing the release of proinflammatory cytokines interleukin (IL)-1β and IL-18. Studies have demonstrated a close link between the NLRP3 inflammasome and central nervous system diseases. Nevertheless, the involvement of NLRP3 inflammasome in the causation of PND occurring after cardiac surgery is unclear. This study aimed to investigate the association of serum NLRP3 level with PND.MethodsWe performed a retrospective study, enrolled 75 patients undergoing elective cardiac surgery and evaluated their cognitive functions one day before and 7 days after surgery. PND were determined according to the International Study of Postoperative Cognitive Dysfunction studies. Demographics and perioperative parameters were recorded. Perioperative serum NLRP3 protein, IL-1β, and IL-18 levels were monitored.ResultsThe PND incidence in our cohort was 33.33%. NLRP3 protein levels were significantly increased in all patients at each postoperative time-point after general anesthesia and cardiac surgery under cardiopulmonary bypass. Patients showing cognitive dysfunction had higher serum NLRP3 protein, caspase-1, IL-1β, and IL-18 levels immediately after the operation. Variables associated with the incidence of early PND were included in the regression models. After adjusting for confounding variables, high serum NLRP3 protein level at the end of the operation and old age were identified as independent predictors of PND.ConclusionsHigh serum NLRP3 protein level at the completion of cardiac surgery was associated with a higher risk of PND seven days after surgery.Trial registrationThe study was registered at Clinicaltrials.gov (registration number: NCT04191642).

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Section: Discussionsupporting

confidence: 92%

NLRP3 inflammasome activation contributes to the cognitive decline after cardiac surgery

Sun

Chen

et al. 2022

Front. Surg.

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“…Prior research indicated that cardiac surgery has been associated with higher rates of PND, a serious complication associated with high morbidity and mortality ( 38 ) and that the most promising pharmacological strategy to avoid this complication seemed to be perioperative administration of dexmedetomidine ( 9 , 39 ). In recent years, a great deal of research confirmed that dexmedetomidine had a protective effect on multiple organ systems, namely, the heart, lungs, kidneys, liver, and the central nervous system.…”

Section: Discussionmentioning

confidence: 99%

Is Perioperative Dexmedetomidine Associated With a Reduced Risk of Perioperative Neurocognitive Disorders Following Cardiac Surgery? A Systematic Review and Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

2021

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Background: To assess the effect of dexmedetomidine on the reducing risk of perioperative neurocognitive disorders (PNDs) following cardiac surgery.Methods: A systematic review and meta-analysis with trial sequential analysis (TSA) of randomized controlled trials were performed. PubMed, Embase, Cochrane Library, and CNKI databases (to August 16, 2020) were searched for relevant articles to analyze the incidence of PND for intraoperative or postoperative dexmedetomidine administration after cardiac surgery. PND included postoperative cognitive dysfunction (POCD) and postoperative delirium (POD).Results: A total of 24 studies with 3,610 patients were included. Compared with the control group, the incidence of POD in the dexmedetomidine group was significantly lower (odds ratio [OR]: 0.59, 95% CI: 0.43–0.82, P = 0.001), with firm evidence from TSA. Subgroup analyses confirmed that dexmedetomidine reduced the incidence of POD with firm evidence following coronary artery bypass grafting surgery (OR: 0.45, 95% CI: 0.26–0.79, P = 0.005), and intervention during the postoperative period (OR: 0.48, 95% CI: 0.34–0.67, P < 0.001). Furthermore, the incidence of POD in the dexmedetomidine group was also decreased in mixed cardiac surgery (OR: 0.68, 95% CI: 0.47–0.98, P = 0.039). Irrespective of whether “Confusion Assessment Method/Confusion Assessment Method for intensive care unit” or “other tools” were used as diagnostic tools, the results showed a decreased risk of POD in the dexmedetomidine group. There was no significant difference in the incidence of POCD (OR: 0.47, 95% CI: 0.22–1.03, P = 0.060) between the two groups, but this result lacked firm evidence from TSA.Conclusion: The administration of dexmedetomidine during the perioperative period reduced the incidence of POD in patients after cardiac surgery, but there was no significant benefit in the incidence of POCD. The effect of dexmedetomidine on the incidence of POD or POCD following different types of surgery and the optimal dose and timing of dexmedetomidine warrant further investigation.Trial registration: PROSPERO registration number: CRD42020203980. Registered on September 13, 2020.

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“…Aortic cross-clamp time, CPB time, AF, and blood transfusions are the other factors which are thought to be implicated in the etiology of POND. [18][19][20][21][22][23] Operative strategies including single aortic clamp and care against aortic manipulation may reduce the risk for POND by decreasing microembolism. No-touch technique for proximal anastomoses, offpump surgery, and hybrid procedures can be reliable alternatives in patients with AC to prevent POND and overall mortality.…”

Section: Discussionmentioning

confidence: 99%

The relationship between aortic calcification on chest radiograph and neurocognitive impairment after coronary artery bypass grafting

Özhan¹,

Baştopçu²,

Karakaya³

et al. 2021

Turk Gogus Kalp Dama

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Background: In this study, we aimed to investigate the possible relationship between aortic calcification as detected by preoperative chest radiography and postoperative neurocognitive impairment in patients undergoing coronary artery bypass grafting. Methods: A total of 124 patients (101 males, 23 females; mean age: 59.9±8.8 years; range, 34 to 84 years) who underwent coronary artery bypass grafting in our clinic between January 2019 and July 2019 were included. Of these patients, 35 whose preoperative chest radiography revealed aortic calcification in the aortic knuckle were included as the patient group. The control group consisted of 89 patients without aortic calcification. The patients with aortic calcification underwent additional imaging with thoracic computed tomography angiography and ascending aorta and aortic arch calcium scores were calculated. Neurocognitive dysfunction was assessed using the Standardized Mini-Mental State Examination. Postoperative delirium was evaluated by confusion assessment method in the intensive care unit. Both groups were compared for demographic, operative and postoperative data. Results: Of all patients included in the study, the overall cerebrovascular event incidence was 3.2%. Although not statistically significant, the number of patients with neurocognitive decline was higher in the patient group than the control group (48.6% vs. 34.8%, respectively; p=0.157). Both Standardized Mini-Mental State Examination score decline and percentage decline were significantly higher in the patients with high aortic arch calcium scores (>2,250 AU). Carotid artery stenosis was 3.2 times higher in the patient group. In the patients with carotid artery stenosis, the aortic arch calcium scores were also higher (p=0.042). Conclusion: Aortic calcification detectable on chest radiography with high calcium scores may be associated with neurocognitive impairment and carotid artery stenosis in patients undergoing coronary artery bypass grafting.

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Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 1: The problem; nomenclature; delirium and postoperative neurocognitive disorder; and the role of cardiac surgery and anesthesia

Cited by 15 publications

References 72 publications

NLRP3 inflammasome activation contributes to the cognitive decline after cardiac surgery

NLRP3 inflammasome activation contributes to the cognitive decline after cardiac surgery

Is Perioperative Dexmedetomidine Associated With a Reduced Risk of Perioperative Neurocognitive Disorders Following Cardiac Surgery? A Systematic Review and Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

The relationship between aortic calcification on chest radiograph and neurocognitive impairment after coronary artery bypass grafting

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