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Cognitive deficit after aortic valve replacement
Daniel Zimpfer1, Martin Czerny, Juliane Kilo
1Department of Cardio-Thoracic Surgery, Vienna General Hospital, University of Vienna, Austria.
Insights
Cognitive brain function impairment is more pronounced four months after biological aortic valve replacement (AVR) compared to coronary artery bypass grafting (CABG). Further research is needed to understand the ongoing cognitive decline in AVR patients.
Area of Science:
- Cardiovascular Surgery
- Neuroscience
- Cognitive Function
Background:
- Cognitive impairment is a known complication following coronary artery bypass grafting (CABG).
- The neurocognitive effects of aortic valve replacement (AVR) are less understood.
- This study investigates cognitive function after biological AVR versus CABG.
Purpose of the Study:
- To compare cognitive brain function in patients undergoing isolated biological aortic valve replacement (AVR) with age-matched controls undergoing coronary artery bypass grafting (CABG).
- To assess changes in cognitive function using auditory evoked P300 potentials and psychometric tests at different time points post-surgery.
Main Methods:
- A case-matched control study involving 30 patients undergoing isolated AVR with a biological prosthesis and 30 patients undergoing CABG.
- Cognitive function was evaluated using auditory evoked P300 potentials (peak latencies) and psychometric tests (Mini-Mental State Examination, Trailmaking Test A).
- Measurements were taken pre-operatively, 7 days post-operatively, and 4 months post-operatively.
Main Results:
- Auditory evoked P300 potentials showed no significant difference between AVR and CABG groups pre-operatively.
- Both groups experienced temporary P300 latency prolongation one week after surgery.
- Four months post-surgery, P300 latencies normalized in the CABG group but remained prolonged in the AVR group, indicating persistent cognitive impairment.
- Psychometric tests did not reveal significant differences between the groups.
Conclusions:
- Cognitive brain function impairment is more pronounced at four months in patients receiving biological AVR compared to CABG.
- The study suggests a potential for ongoing cognitive impairment in patients with biological aortic valve prostheses.
- Further research is required to elucidate the underlying pathological mechanisms.
Background:
Impairment of cognitive brain function after coronary artery bypass grafting (CABG) is well known. In contrast the potential neurocognitive damage related to aortic valve replacement (AVR) is uncertain.
Methods:
In this contemporary case-matched control study we followed 30 patients (mean age 70 years) receiving isolated AVR with a biological prosthesis. A cohort of sex-and age-matched patients (n = 30, mean age 70 years) receiving CABG with cardiopulmonary bypass served as controls. Cognitive brain function was measured by means of auditory evoked P300 potentials (peak latencies, ms) before the operation and 7 days and 4 months after the operation. Additionally, two standard psychometric tests (Mini-Mental State Examination and the Trailmaking Test A) were performed.
Results:
In preoperative measures there was no difference between patients undergoing AVR and patients undergoing CABG (AVR 378 +/- 37 ms, CABG 374 +/- 32 ms, p = 0.629). One week after surgery P300 peak latencies were prolonged (impaired) in both groups compared with preoperative values (AVR 405 +/- 43 ms, p = 0.001; CABG 398 +/- 44 ms, p = 0.004). At this point of follow-up there was no difference between the groups (p = 0.607). Finally, 4 months after surgery P300 auditory evoked potentials returned to normal in the CABG group (380 +/- 24 ms, p = 0.940) while in contrast in the valve group they continued to become prolonged (worsened) compared with preoperative values (410 +/- 47 ms, p = 0.005). At this time of follow-up P300 peak latencies were prolonged in AVR patients as compared with CABG patients (p = 0.032). The Trailmaking Test A and Mini-Mental State Examination failed to discriminate any difference.
Conclusions:
Four-month impairment of cognitive brain function is more pronounced in patients undergoing biological AVR as compared with age-matched control patients undergoing CABG. Further studies are needed to clarify the potential pathologic mechanisms causing an ongoing cognitive impairment in patients with biological aortic valve prostheses.