Neurocognitive deficit and quality of life after mitral valve repair

Postoperative cognitive dysfunction (POCD) is a relevant complication after cardiac surgery that affects patient outcome. The study aims was to prospectively evaluate neurocognitive functions, quality of life (QoL) and psychological distress following minimally invasive mitral valve (MV) repair.

A total of 98 consecutive patients (64 males, 34 females; mean age 53.7 +/- 10.3 years; mean logistic EuroSCORE 3.23 +/- 2.90) who underwent MV repair through a Hearthport Port-Access system was enrolled in the study. Neurocognitive evaluations were performed using the Mini-Mental State Examination, Trail-Making Test (TMT-A and -B) and digit span shortly before surgery, at hospital discharge, and at three months postoperatively. Measures of QoL (Medical Outcomes, Study Short Form, SF-36) and psychological distress (Hospital Anxiety and Depression Scale, HADS) were also undertaken.

The large degree of POCD referred to in other studies was not observed; rather, a clear sign of improvement was observed when considering TMT-B (p <0.001) and digit span forward (p < 0.05) tests at the three-month follow up. These results also agreed with the QoL and mood state indices, which showed improvements (p < 0.05) in all SF-36 and HADS scores. No significant relationship was found between neurocognitive impairment and the cross-clamp and cardiopulmonary bypass times.

The study results highlighted the low risk of neurocognitive deficits after MV repair. A substantial improvement in the patients' neurocognitive assessment and QoL, from the preoperative condition to the three-month follow up after surgery, was observed. However, the small number of patients demonstrating a clear cognitive decline made it difficult to identify causative factors for POCD.