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Effect of asymptomatic carotid artery disease on cognitive outcome after cardiopulmonary bypass
G Vingerhoets1, G Van Nooten, C Jannes
1Department of Psychiatry and Neuropsychology, University Gent, Belgium.
Insights
Asymptomatic carotid artery disease did not worsen cognitive decline after cardiopulmonary bypass surgery. Postoperative cognitive dysfunction was temporary and resolved within six months for all patients.
Area of Science:
- Cardiovascular Surgery
- Neuropsychology
- Vascular Disease
Background:
- Cardiopulmonary bypass (CPB) is associated with postoperative cognitive dysfunction.
- The role of asymptomatic carotid artery disease in this cognitive outcome is not fully understood.
Purpose of the Study:
- To investigate the effect of asymptomatic carotid artery disease on cognitive outcomes following CPB.
- To determine if carotid artery disease exacerbates or influences postoperative cognitive performance.
Main Methods:
- Prospective study of 104 patients undergoing cardiac surgery with CPB.
- Preoperative duplex B mode Doppler scan to assess internal carotid arteries.
- Neuropsychological examinations at baseline, 8 days, and 6 months post-surgery.
Main Results:
- Patients exhibited temporary selective cognitive dysfunction early after CPB.
- Cognitive deficits resolved by the sixth postoperative month.
- No significant difference in cognitive outcomes between patients with and without asymptomatic carotid artery disease.
Conclusions:
- Mild to moderate asymptomatic carotid artery disease does not significantly impact cognitive outcomes after CPB.
- Postoperative cognitive dysfunction following CPB appears to be transient and not primarily driven by carotid artery disease.
Abstract:
This prospective study reinvestigates the effect of asymptomatic carotid artery disease on the cognitive outcome after cardiopulmonary bypass (CPB) (Harrison et al., 1989). Patients (N = 104) scheduled for cardiac surgery using CPB were classified in one of two groups based on the results of a preoperative duplex B mode Doppler scan of the internal carotid arteries. All patients received a neuropsychological examination before surgery, 8 days after surgery, and 6 months after surgery (n = 79). When group data are considered, patients showed evidence of selective cognitive dysfunction early after surgery. These dysfunctions were resolved by the sixth postoperative month. We found no indications that the presence of asymptomatic carotid artery disease increased the incidence of cognitive disturbances after CPB or differentially affected the postoperative performance. We conclude that mild to moderate asymptomatic carotid artery disease does not appear to play a major role in the genesis of postoperative neuropsychological sequelae.