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Related Experiment Videos

Executive cognitive dysfunction without stroke after long-term mechanical circulatory support.

Takeshi Komoda1, Thorsten Drews, Shigeru Sakuraba

  • 1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany. komoda@dhzb.de

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|December 13, 2005
PubMed
Summary

Patients undergoing heart transplantation after long-term mechanical circulatory support (MCS) with detected left ventricular assist device (LVAD) thrombus showed executive cognitive dysfunction. This suggests LVAD thrombus may cause cognitive impairment without stroke.

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Area of Science:

  • Cardiology
  • Neuropsychology
  • Medical Engineering

Background:

  • Heart transplantation (HTx) patients with long-term mechanical circulatory support (MCS) may develop executive cognitive dysfunction.
  • The role of device-related complications, such as thrombus formation in left ventricular assist devices (LVADs), in this dysfunction is unclear.
  • This study investigates cognitive function in HTx patients with and without a history of MCS, focusing on LVAD thrombus presence.

Purpose of the Study:

  • To investigate executive cognitive function in heart transplant recipients.
  • To determine if prior long-term mechanical circulatory support, specifically with detected left ventricular assist device thrombus, is associated with cognitive deficits.
  • To explore the potential link between LVAD thrombus formation and executive dysfunction.

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Main Methods:

  • Fifty male heart transplant recipients (aged 20-59, no stroke history) were studied.
  • Patients were categorized into: control group (no MCS), MCS group with no detectable LVAD thrombus (AH group), and MCS group with detected LVAD thrombus (AH-Thr group).
  • Cognitive function was assessed using the Trail Making Test (TMT) and Wisconsin Card Sorting Test (WCST).

Main Results:

  • The AH-Thr group exhibited significantly poorer performance on TMT part B (longer completion time, p < 0.05) compared to control and AH groups.
  • The AH-Thr group also showed significantly more perseverative errors on the WCST (p < 0.001) compared to the other groups.
  • These findings indicate executive dysfunction in set-shifting ability within the AH-Thr group, suggesting frontal lobe involvement.

Conclusions:

  • Long-term mechanical circulatory support with detected left ventricular assist device thrombus is associated with executive cognitive dysfunction in heart transplant recipients.
  • The presence of LVAD thrombus may contribute to cognitive impairment, potentially through mechanisms affecting frontal lobe function.
  • Further research is warranted to elucidate the precise mechanisms linking LVAD thrombus formation to neurological complications.