Kidher Emaddin, Harling Leanne, Sugden Colin, Ashrafian Hutan, Casula Roberto, Evans Paul, Nihoyannopoulos Petros, Athanasiou Thanos
Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
Interact Cardiovasc Thorac Surg. 2014 Oct;19(4):595-604. doi: 10.1093/icvts/ivu194. Epub 2014 Jun 13.
Post-cardiac surgical cognitive dysfunction occurs more commonly following valvular procedures. Cognitive function has been related to vascular health status; however, the relation between pre-existent arterial stiffness and perioperative cognitive dysfunction is yet to be defined. The objective of this study was to assess whether aortic stiffness is related to cognitive dysfunction in surgical aortic stenosis (AS) pre- and postoperatively.
Between June 2010 and August 2012, patients undergoing aortic valve replacement (AVR) for AS were recruited for inclusion in this prospective observational study. Aortic pulse wave velocity (PWV) was used as a measure of aortic stiffness and cognitive function was assessed using the computerized Cambridge Neuropsychological Test Automated Battery (CANTAB) preoperatively and (409 ± 159 days) post-AVR.
Fifty-six patients (age 71 ± 8.4 years) were recruited. Of the total, 50 (89%) completed postoperative follow-up. Pre- and postoperatively, patients with normal PWV (PWV-norm) had significantly superior delayed memory, sustained visual attention and executive function compared with those with high PWV (PWV-high). Immediate memory and decision-making were similar between groups. Postoperatively, improvement in cognitive function was more marked in PWV-high compared with PWV-norm patients. In two models of multiple regression analysis, PWV as a continuous variable was independently related to all preoperative main cognitive components as well as postoperative executive function. PWV as a dichotomous variable was independently related to all pre- and postoperative main cognitive function components.
AVR may not be associated with an independent or homogeneous effect on cognitive decline. Aortic PWV might be useful as an additional indicator for cognitive dysfunction before and after surgical intervention for AS.
心脏外科手术后认知功能障碍在瓣膜手术中更为常见。认知功能与血管健康状况有关；然而，术前存在的动脉僵硬度与围手术期认知功能障碍之间的关系尚未明确。本研究的目的是评估主动脉僵硬度与手术主动脉瓣狭窄（AS）术前和术后认知功能障碍是否相关。
在2010年6月至2012年8月期间，招募接受主动脉瓣置换术（AVR）治疗AS的患者纳入本前瞻性观察研究。主动脉脉搏波速度（PWV）用作主动脉僵硬度的指标，术前和AVR术后（409±159天）使用计算机化剑桥神经心理测试自动成套系统（CANTAB）评估认知功能。
招募了56例患者（年龄71±8.4岁）。其中，50例（89%）完成了术后随访。术前和术后，PWV正常（PWV - norm）的患者与PWV高（PWV - high）的患者相比，在延迟记忆、持续视觉注意力和执行功能方面明显更优。两组之间的即时记忆和决策能力相似。术后，与PWV - norm患者相比，PWV - high患者的认知功能改善更为明显。在两个多元回归分析模型中，PWV作为连续变量与所有术前主要认知成分以及术后执行功能独立相关。PWV作为二分变量与所有术前和术后主要认知功能成分独立相关。
AVR可能与认知衰退没有独立或同质的影响。主动脉PWV可能作为AS手术干预前后认知功能障碍的额外指标。
