Knipp Stephan C, Weimar Christian, Schlamann Marc, Schweter Sebastian, Wendt Daniel, Thielmann Matthias, Benedik Jaroslav, Jakob Heinz
Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, Essen, Germany.
Department of NeurologyUniversity Hospital Essen, Essen, Germany.
Interact Cardiovasc Thorac Surg. 2017 Apr 1;24(4):534-540. doi: 10.1093/icvts/ivw421.
Adverse cognitive outcome is well recognized after coronary artery bypass grafting (CABG) while little is known about the extent and duration of decline after cardiac valve surgery. We investigated changes in cognitive function following conventional cardiac valve surgery over up to 4 years.
Among 36 patients (65.2 ± 9.2 years, 36% women) who received valve surgery, we assessed serial cognitive function with a battery of 11 standardized tests across 3-4 years. Cognitive function was analysed to identify: (1) cognitive decline (i.e. within-patient changes in test scores) and (2) cognitive deficit (i.e. drop of score ≥1 SD in ≥3 tests). Diffusion-weighted magnetic resonance imaging (DW-MRI) was applied pre- and post-procedure to detect ischaemic brain injury. Data were compared to a historical cohort of 39 patients undergoing CABG.
After both valve surgery and CABG, a significant decline at discharge was detected in 7 of 11 cognitive tests. The rate of patients with a cognitive deficit after valve surgery vs CABG was 39% vs 56% at discharge, 14% vs 23% at 3 months, and 16% vs 26% at 3-4 years (not significant, [n.s.]). After valve surgery, DW-MRI identified 19 (53%) patients with evidence of 50 new focal ischaemic lesions (CABG: 20 [51%] patients with 42 lesions, n.s.). Cumulative cerebral ischaemic load per patient was not significantly different between the valve surgery group and CABG group (503 ± 485 mm 3 vs 415 ± 234 mm 3 ). After correction for multiple potential risk factors in both groups, reduced verbal memory at discharge could be identified as a predictor of long-term cognitive impairment in CABG patients only ( P = 0.04). For both the valve surgery and CABG group, no association between cognitive impairment and new ischaemic cerebral lesions was found.
The course of cognitive performance after valve surgery and CABG was similar with early postoperative decline followed by subsequent recovery. Although silent small brain infarcts were present in about half of all patients, they did not impact cognitive performance neither at early nor during long-term follow-up.
冠状动脉旁路移植术（CABG）后不良认知结局已得到充分认识，而关于心脏瓣膜手术后认知功能下降的程度和持续时间知之甚少。我们调查了传统心脏瓣膜手术后长达4年的认知功能变化。
在36例接受瓣膜手术的患者（65.2±9.2岁，36%为女性）中，我们在3至4年的时间里通过一系列11项标准化测试对其进行了连续认知功能评估。对认知功能进行分析以确定：（1）认知下降（即患者自身测试分数的变化）和（2）认知缺陷（即≥3项测试中分数下降≥1个标准差）。在手术前后应用扩散加权磁共振成像（DW-MRI）检测缺血性脑损伤。将数据与39例接受CABG的历史队列患者进行比较。
瓣膜手术和CABG后，11项认知测试中有7项在出院时出现显著下降。瓣膜手术与CABG后出院时认知缺陷患者的比例分别为39%和56%，3个月时为14%和23%，3至4年时为16%和26%（无显著差异，[n.s.]）。瓣膜手术后，DW-MRI发现19例（53%）患者有50个新的局灶性缺血性病变（CABG：20例[51%]患者有42个病变，无显著差异）。瓣膜手术组和CABG组患者的累积脑缺血负荷无显著差异（503±485mm³对415±234mm³）。在对两组中的多个潜在风险因素进行校正后，仅在CABG患者中发现出院时言语记忆减退可作为长期认知障碍的预测指标（P = 0.04）。对于瓣膜手术组和CABG组，均未发现认知障碍与新的缺血性脑病变之间存在关联。
瓣膜手术和CABG后的认知表现过程相似，术后早期下降随后恢复。尽管约一半的患者存在无症状性小脑梗死，但它们在早期和长期随访中均未影响认知表现。
