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More continuous flow, better learning? The effect of aortic valve opening in patients with left ventricular assist
Mehmet Karahan1, Sinan Sabit Kocabeyoglu1, Umit Kervan1
1Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
Insights
Continuous flow left ventricular assist device (LVAD) implantation did not impair neurocognitive functions. Patients with LVAD showed better learning performance, suggesting improved cognitive function with continuous cerebral blood flow.
Area of Science:
- Cardiology
- Neuroscience
- Medical Devices
Background:
- Heart failure significantly impacts neurocognitive function.
- Left ventricular assist devices (LVADs) are crucial for end-stage heart failure management.
- Continuous-flow LVADs aim to improve hemodynamics and end-organ perfusion.
Purpose of the Study:
- To evaluate neurocognitive function in patients implanted with continuous-flow LVADs.
- To compare neurocognitive performance between LVAD recipients, heart failure patients, and healthy controls.
- To investigate the influence of aortic valve opening (AVO) on neurocognitive outcomes in LVAD patients.
Main Methods:
- Cross-sectional study comparing three groups: LVAD recipients (n=31), heart failure patients (n=26), and healthy volunteers (n=27).
- Neurocognitive assessment using Rey Auditory-Verbal Learning Test (RAVLT), Judgement of Line Orientation Test (JLOT), Trail Making Test (TMT), Stroop Color-Word Interference Test (SCWIT), Verbal Fluency Test (VFT), and Symbol-Digit Modality Test (SDMT).
- LVAD patients subgrouped by aortic valve opening (AVO): closed (n=9), 1-6 (n=8), and 7-10 (n=14) per ten beats.
Main Results:
- No significant differences in SCWIT, JLOT, SDMT, TMT, and VFT scores among the three groups.
- LVAD recipients demonstrated significantly better RAVLT scores compared to heart failure patients and healthy controls.
- Patients with AVO '7-10' exhibited longer response times and lower learning scores than those without AVO.
Conclusions:
- Continuous-flow LVAD implantation does not impair neurocognitive functions.
- Improved learning performance observed in LVAD patients, particularly with no AVO, suggests potential cognitive benefits from continuous cerebral blood flow.
- These findings indicate that continuous cerebral perfusion from LVADs may not only preserve but potentially enhance learning capabilities.
Purpose:
The aim of this study was to analyze neurocognitive function in patients who underwent continuous flow left ventricular assist device (LVAD) implantation.
Material And Method:
This cross-sectional study included three groups: LVAD (n = 31), heart failure patients (n = 26), and healthy volunteers (n = 27). The Rey Auditory-Verbal Learning Test (RAVLT), Judgement of Line Orientation Test (JLOT), Trail Making Test (TMT), Stroop Color-Word Interference Test (SCWIT), Verbal Fluency Test (VFT), Symbol-Digit Modality Test (SDMT) were used to assess the neurocognitive functions. Data were analyzed at a median 12 (3-47) months after LVAD implantation. The LVAD patients were also divided by aortic valve opening (AVO) into three subgroups as "closed" (n = 9), "1-6" (n = 8) and "7-10" (n = 14) opening per ten beats and data were re-analyzed accordingly.
Results:
There was no significant difference among the groups according to SCWIT, JLOT, SDMT, TMT, and VFT scores. Post-hoc analyzes of RAVLT scores showed significant differences between the LVAD and the other two groups in favor of the LVAD group. Also, the patients with AVO "7-10" the response times were longer and learning scores were found to be lower than those without AVO.
Conclusion:
With continuous-flow LVAD, neurocognitive functions were not impaired. The learning performance was better in cases where there was no AVO and flow was completely device dependent. We may speculate that neurocognitive functions are not worsening with continuous cerebral blood flow and even it may improve learning performance.
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