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Published on: March 27, 2018
Assessment of long-term cognitive impairment after off-pump coronary-artery bypass grafting and related risk factors
Luis M Pérez-Belmonte1, Carlos M San Román-Terán2, Manuel Jiménez-Navarro3
1CMU (Clinical Management Unit) of Heart Department, Virgen de la Victoria University Hospital, Málaga, Spain; Unit of Cognitive Neurophysiology, Research Medical Center of Málaga University, ICE (International Campus of Excellence) Andalucía Tech, BRIM (Biomedical Research Institute of Málaga), Málaga, Spain.
Insights
Cognitive impairment is common after off-pump coronary artery bypass grafting, affecting over half of patients at six months. While some recovery occurs by twelve months, risk factors like smoking and diabetes predict impairment.
Area of Science:
- Cardiovascular Surgery
- Neuropsychology
- Medical Research
Background:
- Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure to improve blood flow to the heart.
- Cognitive impairment following cardiac surgery is a recognized complication.
- Long-term neurocognitive outcomes after OPCAB require further investigation.
Purpose of the Study:
- To evaluate the incidence and pattern of cognitive impairment after OPCAB.
- To identify risk factors associated with postoperative cognitive dysfunction.
- To assess the long-term recovery of cognitive function post-OPCAB.
Main Methods:
- A prospective study was conducted with 36 patients undergoing OPCAB.
- Neuropsychological tests were administered preoperatively and at 1, 6, and 12 months postoperatively.
- Cognitive impairment was defined as a significant decrease in test performance.
Main Results:
- Significant multidomain cognitive impairment was observed post-OPCAB, affecting attention, memory, and verbal fluency.
- The highest prevalence of impairment was at 6 months (over 50%), with over 30% still affected at 12 months.
- Smoking, diabetes, peripheral arteriopathy, obesity, lower hematocrit/hemoglobin, and diastolic blood pressure predicted impairment; better NYHA class and less angina severity correlated with recovery.
Conclusions:
- Long-term, multidomain cognitive impairment and partial neurocognitive recovery occur after OPCAB.
- Nonspecific factors related to surgery and patient comorbidities influence cognitive outcomes.
- Findings underscore the need for pre-operative patient counseling and long-term neurocognitive monitoring.
Objectives:
To assess cognitive impairment after off-pump coronary-artery bypass grafting, with a particular emphasis on long-term follow-up and related risk factors.
Design:
Prospective study.
Setting:
Virgen de la Victoria University Hospital, Málaga, Spain.
Participants:
Participants were 36 patients undergoing off-pump coronary-artery bypass grafting.
Measurements:
Changes in the neuropsychological test battery administered from before to after surgery (1, 6, and 12 months). Postoperative cognitive impairment was defined by a significant decrease.
Results:
A significantly multidomain (attention-executive functions, P < .01; immediate and delayed memory, P < .001; and verbal fluency, P < .05) postoperative cognitive impairment was shown, being maximum at 6 months (more than 50% of patients) and still presented at 12 months (more than 30% of patients), but partially recovered. Related risk factors as smoking (P < .01), diabetes mellitus (P < .01), peripheral arteriopathy (P < .01), obesity (P < .05), lower hematocrit (P < .01), and hemoglobin (P < .05) levels and diastolic blood pressure (P < .05) were identified as predictors of cognitive impairment. Better New York Heart Association class (P < .01) and less severity of angina (P < .01) were associated with partial postoperative recovering.
Conclusion:
A multidomain long-term postoperative cognitive impairment and a partial neurocognitive recovering were detected after off-pump coronary-artery bypass grafting and were associated with several nonspecific surgery factors. These findings may be useful when counseling patients before surgery and suggest the importance of long-term neurocognitive evaluation.
