Butz Marius, El-Shazly Jasmin, Gerriets Tibo, Meyer Rolf, Tschernatsch Marlene, Braun Tobias, Schramm Patrick, Doeppner Thorsten R, Gerner Stefan T, Boening Andreas, Choi Yeong-Hoon, Schoenburg Markus, Juenemann Martin
Heart and Brain Research Group, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany.
Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany.
CJC Open. 2023 Nov 15;6(4):615-623. doi: 10.1016/j.cjco.2023.11.007. eCollection 2024 Apr.
Postoperative cognitive decline (POCD) after cardiosurgical interventions are well described through objective psychometric tests. However, a patient's subjective perception is essential to clinical assessment and quality of life. This study systematically evaluated patient-reported POCD between subjects undergoing coronary artery bypass grafting and heart valve replacement.
This study was a multicentre, prospective questionnaire survey conducted at the cardiac surgery departments at the Kerckhoff Clinic in Bad Nauheim and the University Hospital in Giessen, Germany. We included patients undergoing elective coronary artery bypass grafting (CABG), aortic valve replacement (AVR), mitral valve replacement or reconstruction (MVR), and combined surgery (CABG + valve replacement [VR]) with extracorporeal circulation. The Hospital Anxiety and Depression Scale, the Cognitive Failures Questionnaire (CFQ) for Self-assessment (CFQ-S), and the external assessment (CFQ-foreign [F]) were completed preoperatively, as well as at 3 and 12 months postoperatively.
A total of 491 patients were available for analyses (CABG = 182, AVR = 134, MVR = 93, CABG + VR = 82). POCD and postoperative depression increase (PODI) were observed for each surgical procedure. (At the 3-month follow-up: CFQ-S [CABG = 7.1%, AVR = 3.7%, MVR = 9.7%, CABG + VR = 9.8%]; CFQ-F [CABG = 9.9%, AVR = 9.7%, MVR = 9.7%, CABG + VR = 15.9%]; PODI [CABG = 7.7%, AVR = 9.7%, MVR = 6.5%, CABG + VR = 8.5%]. At the 12-month follow-up: CFQ-S [CABG = 6.6%, AVR = 7.5%, MVR = 15.1%, CABG + VR = 7.3%]; CFQ-F [CABG = 7.1%, AVR = 14.9%, MVR = 10.8%, CABG + VR = 9.8%]; PODI [CABG = 10.4%, AVR = 11.2%, MVR = 6.5%, CABG + VR = 4.9%]). No significant between-group effects were observed for the CFQ-S, CFQ-F, or the Hospital Anxiety and Depression Scale.
For clinicians, paying attention to patients' self-reported experiences of reduced cognitive function and symptoms of depression following cardiac surgery is important. Such reporting is an indication that interventions such as cognitive training or psychotherapy should be considered.
心脏外科手术后的术后认知功能下降（POCD）可通过客观的心理测量测试得到充分描述。然而，患者的主观感受对于临床评估和生活质量至关重要。本研究系统评估了接受冠状动脉搭桥术和心脏瓣膜置换术的患者中患者报告的POCD情况。
本研究是在德国巴特瑙海姆的克尔克霍夫诊所和吉森大学医院的心脏外科进行的一项多中心前瞻性问卷调查。我们纳入了接受择期冠状动脉搭桥术（CABG）、主动脉瓣置换术（AVR）、二尖瓣置换或重建术（MVR）以及体外循环下联合手术（CABG + 瓣膜置换术[VR]）的患者。术前以及术后3个月和12个月完成医院焦虑抑郁量表、自我评估认知失误问卷（CFQ-S）和外部评估（CFQ-他人评估[F]）。
共有491例患者可供分析（CABG = 182例，AVR = 134例，MVR = 93例，CABG + VR = 82例）。每种手术均观察到POCD和术后抑郁增加（PODI）。（在3个月随访时：CFQ-S[CABG = 7.1%，AVR = 3.7%，MVR = 9.7%，CABG + VR = 9.8%]；CFQ-F[CABG = 9.9%，AVR = 9.7%，MVR = 9.7%，CABG + VR = 15.9%]；PODI[CABG = 7.7%，AVR = 9.7%，MVR = 6.5%，CABG + VR = 8.5%]。在12个月随访时：CFQ-S[CABG = 6.6%，AVR = 7.5%，MVR = 15.1%，CABG + VR = 7.3%]；CFQ-F[CABG = 7.1%，AVR = 14.9%，MVR = 10.8%，CABG + VR = 9.8%]；PODI[CABG = 10.4%，AVR = 11.2%，MVR = 6.5%，CABG + VR = 4.9%]）。CFQ-S、CFQ-F或医院焦虑抑郁量表未观察到显著的组间效应。
对于临床医生而言，关注患者报告的心脏手术后认知功能下降和抑郁症状的经历很重要。此类报告表明应考虑进行认知训练或心理治疗等干预措施。
