Ferrari Renata, Vidotto Giulio, Muzzolon Cristina, Auriemma Stefano, Salvador Loris
J Heart Valve Dis. 2014 Jan;23(1):72-8.
Postoperative cognitive dysfunction (POCD) is a relevant complication after cardiac surgery that affects patient outcome. The study aims was to prospectively evaluate neurocognitive functions, quality of life (QoL) and psychological distress following minimally invasive mitral valve (MV) repair.
A total of 98 consecutive patients (64 males, 34 females; mean age 53.7 +/- 10.3 years; mean logistic EuroSCORE 3.23 +/- 2.90) who underwent MV repair through a Hearthport Port-Access system was enrolled in the study. Neurocognitive evaluations were performed using the Mini-Mental State Examination, Trail-Making Test (TMT-A and -B) and digit span shortly before surgery, at hospital discharge, and at three months postoperatively. Measures of QoL (Medical Outcomes, Study Short Form, SF-36) and psychological distress (Hospital Anxiety and Depression Scale, HADS) were also undertaken.
The large degree of POCD referred to in other studies was not observed; rather, a clear sign of improvement was observed when considering TMT-B (p <0.001) and digit span forward (p < 0.05) tests at the three-month follow up. These results also agreed with the QoL and mood state indices, which showed improvements (p < 0.05) in all SF-36 and HADS scores. No significant relationship was found between neurocognitive impairment and the cross-clamp and cardiopulmonary bypass times.
The study results highlighted the low risk of neurocognitive deficits after MV repair. A substantial improvement in the patients' neurocognitive assessment and QoL, from the preoperative condition to the three-month follow up after surgery, was observed. However, the small number of patients demonstrating a clear cognitive decline made it difficult to identify causative factors for POCD.
术后认知功能障碍（POCD）是心脏手术后一种相关并发症，会影响患者预后。本研究旨在前瞻性评估微创二尖瓣（MV）修复术后的神经认知功能、生活质量（QoL）和心理困扰。
本研究纳入了98例连续接受通过Hearthport Port-Access系统进行MV修复的患者（64例男性，34例女性；平均年龄53.7±10.3岁；平均逻辑欧洲心脏手术风险评估系统评分为3.23±2.90）。在手术前、出院时及术后三个月，使用简易精神状态检查表、连线测验（TMT-A和-B）和数字广度进行神经认知评估。还进行了生活质量（医学结局研究简表，SF-36）和心理困扰（医院焦虑抑郁量表，HADS）的测量。
未观察到其他研究中提及的严重程度的POCD；相反，在三个月随访时考虑TMT-B（p<0.001）和数字广度顺背（p<0.05）测试时，观察到明显的改善迹象。这些结果也与生活质量和情绪状态指标一致，所有SF-36和HADS评分均显示改善（p<0.05）。未发现神经认知障碍与主动脉阻断和体外循环时间之间存在显著关系。
研究结果突出了MV修复术后神经认知缺陷的低风险。观察到患者从术前状态到术后三个月随访时神经认知评估和生活质量有显著改善。然而，少数表现出明显认知下降的患者使得难以确定POCD的致病因素。
