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Cerebral dysfunction after cardiac operations in elderly patients
E J Heyer1, E Delphin, D C Adams
1Department of Anesthesiology, Columbia University, New York, New York 10032-3784, USA.
Insights
Elderly patients undergoing open chamber cardiac operations show increased early cerebral dysfunction compared to younger patients or those having noncardiac surgery. These cognitive changes are temporary and do not persist long-term.
Area of Science:
- Neurology
- Cardiology
- Geriatrics
Background:
- Cerebral injury is a known complication of cardiac surgery.
- Assessing cerebral dysfunction incidence in elderly cardiac surgery patients is crucial.
Purpose of the Study:
- To compare the incidence of cerebral dysfunction in elderly patients undergoing open chamber cardiac operations versus younger cardiac surgery patients and age-matched noncardiac surgery patients.
Main Methods:
- Prospective study of 68 patients (cardiac vs. noncardiac, elderly vs. younger).
- Preoperative and postoperative neurologic examinations and neuropsychometric testing.
- Follow-up testing at later stages.
Main Results:
- All groups showed new primitive reflexes postoperatively, with no significant difference.
- Group 1 (elderly cardiac) showed distinct neuropsychometric performance differences early post-op compared to groups 2 and 3.
- These differences resolved by late follow-up.
Conclusions:
- Elderly patients undergoing open chamber cardiac operations experience more early postoperative cerebral dysfunction.
- This dysfunction is more pronounced than in younger cardiac surgery patients or elderly noncardiac surgery patients.
- Cognitive deficits are transient and do not persist long-term.
Background:
Cerebral injury remains a significant complication of cardiac operations. We determined the incidence of cerebral dysfunction in a population of elderly patients undergoing open chamber cardiac operations (group 1) as compared with a younger population (group 2) and an age-matched group of elderly patients undergoing major noncardiac operations (group 3).
Methods:
Sixty-eight patients (55 for open chamber cardiac operations and 13 for noncardiac operations) were prospectively studied. Patients were evaluated preoperatively and postoperatively before hospital discharge using a complete neurologic examination and a battery of standard neuropsychometric tests, and at surgical follow-up with neuropsychometric tests only.
Results:
Postoperative changes detected by neurologic examination consisted of the appearance of new primitive reflexes in all groups. No statistically significant differences in incidence were found. The neuropsychometric performance of group 1 patients was statistically different from that of patients in groups 2 and 3 only in the early follow-up period.
Conclusions:
Elderly patients having open chamber cardiac operations exhibit significantly more cerebral dysfunction in the early postoperative period than those undergoing major noncardiac operations and younger patients after open chamber procedures. These changes do not persist into the late follow-up period.