Research Long-term Cognitive Impairment After Off-Pump Versus On-Pump Cardiac Surgery: Involved Risk Factors

Pérez‐Belmonte, Luis M.; Florido-Santiago, M.; Millán-Gómez, Mercedes; Barbancho, Miguel Ángel; Gómez‐Huelgas, Ricardo; Lara, José Pablo

doi:10.1016/j.jamda.2018.02.012

Cited by 8 publications

(8 citation statements)

References 8 publications

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“…Finally, to improve cognitive outcomes following cardiac surgery, several novel techniques have been introduced, such as the “no-touch” approach [64], the single-clamp technique [65], ultrafiltration- and leukocyte-depletion methods [19], pulsatile flow [31], minimized extracorporeal circulation [2] and cell saver devices [24], while the alpha-stat technique compared to the pH-stat technique [27], as well as a shorter clamp and CPB duration [66], have been considered preferable.…”

Section: Surgery Perfusion-related Risk Factorsmentioning

confidence: 99%

“…Furthermore, magnetic resonance brain imaging has revealed that a significant portion of the elderly population has experienced asymptomatic stroke that altered cerebral autoregulation, predisposing them to POCD occurrence [11]. Additionally, coronary artery disease represents an independent risk factor for POCD [66,68], as cognitive deterioration was shown to be similar if the patients were surgically or conservatively treated [69]. However, in patients with a preoperative low cardiac output, the surgical procedure improves cognitive functions [70].…”

Section: Patient-related Risk Factorsmentioning

confidence: 99%

“…However, in patients with a preoperative low cardiac output, the surgical procedure improves cognitive functions [70]. Advanced peripheral artery disease is also considered to be a POCD risk factor [66], but evidence of an association between intermittent claudication and cognitive disturbances is contradictory [71].…”

Section: Patient-related Risk Factorsmentioning

confidence: 99%

“…Genetic studies have revealed that certain combinations of C-reactive protein, interleukin-6, tumor necrosis factor-alpha and P-selectin polymorphisms, through modulation of the inflammatory response, contribute to the pathogenesis of POCD [1,27]. A relationship of lower education [6,80], smoking history [66], loneliness [4] and hospital environment [20] with POCD occurrence is also described in the literature.…”

Section: Patient-related Risk Factorsmentioning

confidence: 99%

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Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

2019

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The growing number of publications concerning postoperative cognitive decline (POCD) after cardiac surgery is indicative of the health-related and economic-related importance of this intriguing issue. Significantly, the reported POCD incidence over the years has remained steady due to various unresolved challenges regarding the examination of this multidisciplinary topic. In particular, a universally accepted POCD definition has not been established, and the pathogenesis is still vaguely understood. However, numerous recent studies have focused on the role of the inflammatory response to a surgical procedure in POCD occurrence. Therefore, this traditional narrative review summarizes and evaluates the latest findings, with special attention paid to the difficulties of defining POCD as well as the involvement of inflammation in POCD development. We searched the MEDLINE, Scopus, PsycINFO and CENTRAL databases for the best evidence, which was classified according to the Oxford Centre for Evidence-based Medicine. To our knowledge, this is the first narrative review that identified class-1 evidence (systematic review of randomized trials), although most evidence is still at class-2 or below. Furthermore, we revealed that defining POCD is a very controversial matter and that the inflammatory response plays an important role in the mutually overlapping processes included in POCD development. Thus, developing the definition of POCD represents an absolute priority in POCD investigations, and the inflammatory response to cardiac surgery merits further research.

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Section: Surgery Perfusion-related Risk Factorsmentioning

confidence: 99%

Section: Patient-related Risk Factorsmentioning

confidence: 99%

Section: Patient-related Risk Factorsmentioning

confidence: 99%

Section: Patient-related Risk Factorsmentioning

confidence: 99%

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Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

2019

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“…atherosclerotic burden, hypertension, diabetes) 106 that may be associated with an increased risk of postoperative cognitive decline. 107,108 There have been no changes in DNR and postoperative NCD rates over time (from 1995 to 2019). This might be explained by the fact that, in spite of surgical and perioperative efforts to improve patient outcome, an impact on cognitive outcome is difficult to detect.…”

Section: Discussionmentioning

confidence: 99%

Targeted temperature management in cardiac surgery: a systematic review and meta-analysis on postoperative cognitive outcomes

Linassi

Maran

Laurenzis

et al. 2022

British Journal of Anaesthesia

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Background: Postoperative cognitive decline occurs commonly after cardiac surgery. The available literature is inconclusive on the role of intraoperative causal or protective factors. Methods: We systematically reviewed studies evaluating delayed neurocognitive recovery (DNR), postoperative neurocognitive disorder (NCD), stroke, and the mortality rates among patients undergoing hypothermic or normothermic cardiopulmonary bypass (CPB). We further performed a subgroup analysis for age, surgery type (coronary artery bypass grafting [CABG], valve surgery, or combined), and the mean arterial blood pressure (MAP) during CPB, and conducted a proportion meta-analysis after calculation of single proportions and confidence intervals (CIs). Results: We included a total of 58 studies with 9609 patients in our analysis. Among these, 1906 of 4010 patients (47.5%) had DNR, and 2071 of 7160 (28.9%) had postoperative NCD. Ninety of 4625 patients (2.0%) had a stroke, and 174 of 7589 (2.3%) died. There was no statistically significant relationship between the considered variables and DNR, NCD, stroke, and mortality. In the subgroup analysis comparing hypothermic with normothermic CPB, we found higher NCD rates after combined surgery; for normothermic CPB cases only, the rates of DNR and NCD were lower after combined surgery compared with CABG surgery. A MAP >70 mm Hg compared with MAP¼50e70 mm Hg during CPB was associated with a lower rate of DNR. Conclusions: Temperature, MAP during cardiopulmonary bypass age, and surgery type were not associated with neurocognitive disorders, stroke, and mortality in cardiac surgery. Normothermic cardiopulmonary bypass, particularly when performed with MAP >70 mm Hg, may reduce the risk of postoperative neurocognitive decline after cardiac surgery. PROSPERO registration number: CRD42019140844.

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Assessment of long-term cognitive dysfunction in older patients who undergo heart surgery

et al. 2023

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Research Long-term Cognitive Impairment After Off-Pump Versus On-Pump Cardiac Surgery: Involved Risk Factors

Cited by 8 publications

References 8 publications

Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review of Current Knowledge in 2019

Targeted temperature management in cardiac surgery: a systematic review and meta-analysis on postoperative cognitive outcomes

Assessment of long-term cognitive dysfunction in older patients who undergo heart surgery

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