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Domain-specific cognitive dysfunction after cardiac surgery. A secondary analysis of a randomized trial
Anne G Vedel1,2, Frederik Holmgaard1, Volkert Siersma3
1Department of Cardiothoracic Anaesthesiology, Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Acta Anaesthesiologica Scandinavica
|March 21, 2019
Summary
This study found no significant differences in cognitive deterioration patterns between high-target and low-target mean arterial pressure groups after cardiac surgery. However, brain lesions detected by MRI were associated with postoperative cognitive dysfunction (POCD).
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Cardiac surgery can lead to brain injury and cognitive dysfunction.
- The Perfusion Pressure Cerebral Infarcts (PPCI) trial investigated the effects of different mean arterial pressure targets during cardiopulmonary bypass on patients undergoing cardiac surgery.
- This secondary analysis focuses on domain-specific cognitive changes and their relationship with brain lesions.
Purpose of the Study:
- To compare domain-specific cognitive deterioration patterns between high-target (70-80 mmHg) and low-target (40-50 mmHg) mean arterial pressure groups post-cardiac surgery.
- To investigate the association between diffusion-weighted imaging (DWI)-detected brain lesions and postoperative cognitive dysfunction (POCD).
Main Methods:
- Utilized data from 197 patients in the PPCI trial with complete DWI and cognitive function datasets.
- Cognitive function was assessed pre-surgery, at discharge, and 3 months post-surgery.
- Diffusion-weighted magnetic resonance imaging (DWI) was performed at baseline and early post-surgery (days 3-6).
Main Results:
- No statistically significant differences in domain-specific cognitive deterioration were observed between the high-target and low-target groups at discharge.
- Cognitive flexibility and interference susceptibility tests showed the most frequent deterioration, while memory tests showed the least.
- Postoperative cognitive dysfunction (POCD) at discharge was significantly more frequent in patients with DWI-positive brain lesions (OR: 2.24; P=0.036).
Conclusions:
- Domain-specific patterns of POCD were similar between the different mean arterial pressure target groups.
- A significant association exists between the presence of DWI-detected brain lesions and POCD following cardiac surgery.
Keywords:
blood pressurebrain injurycardiopulmonary bypasscoronary artery bypassheart valvesneuroprotectionpostoperative cognitive dysfunctionMore Related Videos
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