Kervan Umit, Cicekcioglu Ferit, Tuluce Hicran, Ozen Anil, Babaroglu Seyhan, Karakas Sibel, Katircioglu Salih Fehmi
Department of Cardiovascular Surgery, Yuksek Ihtisas Hospital of Turkey, Ankara.
Heart Surg Forum. 2011 Dec;14(6):E335-9. doi: 10.1532/HSF98.20101173.
The aim of this study was to compare the postoperative long-term neurocognitive functions of patients who under-went beating-heart mitral valve replacement on cardiopulmonary bypass (CPB) without aorta cross-clamping with those of patients who underwent mitral valve replacement via the classic method.
The study group included 25 randomly selected patients who underwent beating-heart mitral valve surgery. During the same period, 25 patients were randomly selected as controls to undergo mitral valve replacement procedures via the standard ascending aorta-cannulation technique. The clinical and postoperative (2 months) neurocognitive functional data of both groups were compared.
Neurologic deficit was observed in neither group during the postoperative period. There were no statistically significant differences between the control and the study groups with respect to Hospital Anxiety and Depression Scale (HADS) results (HADS: anxiety, P = .653; HADS: depression, P = .225), in the right hemispheric cognitive function test results (Raven's Standard Progressive Matrices [RSPM] and Line Orientation Test [LOT] tests: RSPM, P = .189), and in the left hemispheric cognitive function test results (the Ray Auditory Verbal Learning [RAVL] and Stroop Color-Word Test [SCWT] tests: SCWT 1 time, P = .300; SCWT 2 time, P = .679; SCWT 3 time, P = .336; SCWT 4 time, P = .852; SCWT 5 time, P = .416; RAVL total verbal learning, P = .167; RAVL immediate recall, P = .791; RAVL distraction trial, P = .199; RAVL retention, P = .174; RAVL delayed recall, P = .111; RAVL recognition, P = .282; SCWT 4 mistake, P = .306; SCWT 4 reform, P = .066; SCWT 5 mistake, P = .236; SCWT 5 reform, P = .301).
The technique of mitral valve replacement with normothermic CPB without cross-clamping of the aorta may be safely used for the majority of patients requiring mitral valve replacement without causing deterioration in neurocognitive functions.
本研究旨在比较在体外循环（CPB）下不阻断主动脉进行心脏跳动中二尖瓣置换术的患者与采用经典方法进行二尖瓣置换术的患者术后长期神经认知功能。
研究组包括随机选取的25例行心脏跳动中二尖瓣手术的患者。同期，随机选取25例患者作为对照组，采用标准升主动脉插管技术进行二尖瓣置换术。比较两组的临床及术后（2个月）神经认知功能数据。
术后两组均未观察到神经功能缺损。在医院焦虑抑郁量表（HADS）结果方面（HADS：焦虑，P = 0.653；HADS：抑郁，P = 0.225）、右半球认知功能测试结果（瑞文标准渐进矩阵[RSPM]和直线定向测试[LOT]测试：RSPM，P = 0.189）以及左半球认知功能测试结果方面（雷听觉言语学习[RAVL]和斯特鲁普色词测试[SCWT]测试：SCWT第1次，P = 0.300；SCWT第2次，P = 0.679；SCWT第3次，P = 0.336；SCWT第4次，P = 0.852；SCWT第5次，P = 可见，在医院焦虑抑郁量表（HADS）结果方面（HADS：焦虑，P = 0.653；HADS：抑郁，P = 0.225）、右半球认知功能测试结果（瑞文标准渐进矩阵[RSPM]和直线定向测试[LOT]测试：RSPM，P = 0.189）以及左半球认知功能测试结果方面（雷听觉言语学习[RAVL]和斯特鲁普色词测试[SCWT]测试：SCWT第1次，P = 0.300；SCWT第2次，P = 0.679；SCWT第3次，P = 0.336；SCWT第4次，P = 0.852；SCWT第5次，P = 0.416；RAVL总言语学习，P = 0.167；RAVL即时回忆，P = 0.791；RAVL分心试验，P = 0.199；RAVL保持，P = 0.174；RAVL延迟回忆，P = 0.111；RAVL识别，P = 0.282；SCWT第4次错误，P = 0.306；SCWT第4次改正，P = 0.066；SCWT第5次错误，P = 0.236；SCWT第5次改正，P = 0.301），对照组和研究组之间均无统计学显著差异。
在常温CPB下不阻断主动脉进行二尖瓣置换术的技术可安全用于大多数需要二尖瓣置换术的患者，且不会导致神经认知功能恶化。
