Holinski Sebastian, Staebe Paul, Geyer Torsten, Neumann Konrad, Uebelhack Ralf, Konertz Wolfgang
Department of Cardiovascular Surgery of Charité Hospital, Medical University, Berlin, Germany.
Ann Thorac Cardiovasc Surg. 2013;19(3):195-200. doi: 10.5761/atcs.oa.11.01872. Epub 2012 Aug 31.
Reduction of cognitive function is a possible side effect after cardiac surgery. We investigated the effect of transfemoral versus conventional aortic valve replacement on cognitive performance early after surgery.
50 patients with transfemoral, catheter-based aortic valve implantations were compared to 50 patients with conventional surgical aortic valve replacement. Six neuropsychological subtests from the Syndrom Kurz Test and Alzheimer's Disease Assessment Scale were performed preoperatively and on the third postoperative day in a double blind fashion. To assess the overall cognitive function and the degree of cognitive change across all tests after surgery we combined the six test-scores by principal component analysis.
The preoperative (Spre), as well as postoperative (Spost) overall cognitive function scores, were not significantly different between the groups and showed deterioration within both groups (Spre conv. 0.2 ± 1.0 vs Spost conv. -0.6 ± 1.1, p <0.0005 and Spre transfem. -0.2 ± 1.0 vs Spost transfem. -0.6 ± 1.1, p = 0.002). This decline (Spre -Spost) was not associated with the type of operation (p = 0.1).
Transfemoral aortic valve implantation has no cerebroprotective advantage since it leads also to an early postoperative decline of neuropsychological abilities, which is comparable to conventional aortic valve replacement.
心脏手术后认知功能减退是一种可能的副作用。我们研究了经股动脉与传统主动脉瓣置换术对术后早期认知表现的影响。
将50例行经股动脉导管主动脉瓣植入术的患者与50例行传统外科主动脉瓣置换术的患者进行比较。术前及术后第3天采用双盲法进行综合征简短测试和阿尔茨海默病评估量表中的6项神经心理学子测试。为了评估术后所有测试的整体认知功能和认知变化程度，我们通过主成分分析将6项测试分数合并。
两组术前（Spre）及术后（Spost）整体认知功能评分无显著差异，且两组均出现恶化（传统组Spre 0.2±1.0 vs Spost -0.6±1.1，p<0.0005；经股动脉组Spre -0.2±1.0 vs Spost -0.6±1.1，p = 0.002）。这种下降（Spre - Spost）与手术类型无关（p = 0.1）。
经股动脉主动脉瓣植入术没有脑保护优势，因为它也会导致术后早期神经心理能力下降，这与传统主动脉瓣置换术相当。
