Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 Mar;107(3):787-794.
doi: 10.1016/j.athoracsur.2018.09.057. Epub 2018 Nov 10.

Cognition and Cerebral Infarction in Older Adults After Surgical Aortic Valve Replacement

Tania Giovannetti  1 , Catherine C Price  2 , Molly Fanning  3 , Steven Messé  4 , Sarah J Ratcliffe  5 , Abigail Lyon  3 , Scott E Kasner  4 , Gregory Seidel  6 , Joseph E Bavaria  3 , Wilson Y Szeto  3 , W Clarke Hargrove 3rd  3 , Michael A Acker  3 , Thomas F Floyd  7 ; DENOVO Investigators
Affiliations
Multicenter Study

Cognition and Cerebral Infarction in Older Adults After Surgical Aortic Valve Replacement

Tania Giovannetti et al. Ann Thorac Surg. 2019 Mar.

Abstract

Background: Aortic valve replacement (AVR) for calcific aortic stenosis is associated with high rates of perioperative stroke and silent cerebral infarcts on diffusion-weighted magnetic resonance imaging (MRI), but cognitive outcomes in elderly AVR patients compared with individuals with cardiac disease who do not undergo surgery are uncertain.

Methods: One hundred ninety AVR patients (mean age 76 ± 6 years) and 198 non-surgical participants with cardiovascular disease (mean age 74 ± 6 years) completed comprehensive cognitive testing at baseline (preoperatively) and 4 to 6 weeks and 1 year postoperatively. Surgical participants also completed perioperative stroke evaluations, including postoperative brain MRI. Mixed model analyses and reliable change scores examined cognitive outcomes. Stroke outcomes were evaluated in participants with and without postoperative cognitive dysfunction.

Results: From reliable change scores, only 12.4% of the surgical group demonstrated postoperative cognitive dysfunction at 4 to 6 weeks and 7.5% at 1 year. Although the surgical group had statistically significantly lower scores in working memory/inhibition 4 to 6 weeks after surgery, the groups did not differ at 1 year. In surgical participants, postoperative cognitive dysfunction was associated with a greater number (p < 0.01) and larger total volume (p < 0.01) of acute cerebral infarcts on MRI.

Conclusions: In high-risk, aged participants undergoing surgical AVR for aortic stenosis, postoperative cognitive dysfunction was surprisingly limited and was resolved by 1 year in most. Postoperative cognitive dysfunction at 4 to 6 weeks was associated with more and larger acute cerebral infarcts.

PubMed Disclaimer

Figures

Fig 1.
Fig 1.
Flow diagram of cognitive test completion at each study time point.
Fig 2.
Fig 2.
Marginal predicted composite scores at each time point for surgical (dashed line) and non-surgical (solid line) participants. (A) Episodic memory, (B) Language, (C) Working Memory/inhibition, (D) Attention, and (E) Visuoconstructional skills. Error bars reflect 95% confidence intervals. An asterisk indicates significantly different scores between surgery and non-surgery groups. Significant differences from baseline to 4–6 weeks/1-year are not indicated in the figure (see text).
See this image and copyright information in PMC

Comment in

  • Postoperative Cognitive Dysfunction: A Forgotten Part of the Quality of Life?
    Santarpino G, Moscarelli M. Santarpino G, et al. Ann Thorac Surg. 2019 Nov;108(5):1583. doi: 10.1016/j.athoracsur.2019.03.047. Epub 2019 Apr 16. Ann Thorac Surg. 2019. PMID: 31002768 No abstract available.
  • Reply.
    Giovannetti T, Price CC, Floyd TF. Giovannetti T, et al. Ann Thorac Surg. 2019 Nov;108(5):1583-1584. doi: 10.1016/j.athoracsur.2019.05.006. Epub 2019 Jun 15. Ann Thorac Surg. 2019. PMID: 31653293 No abstract available.

References

    1. Hogue CW Jr, Murphy SF, Schechtman KB, Davila-Roman VG. Risk factors for early or delayed stroke after cardiac surgery. Circulation 1999;100:642–7. - PubMed
    1. Rodriguez RA, Rubens FD, Wozny D, Nathan HJ. Cerebral emboli detected by transcranial Doppler during cardiopulmonary bypass are not correlated with postoperative cognitive deficits. Stroke 2010;41:2229–35. - PubMed
    1. Westaby S, Saatvedt K, White S, Katsumata T, van Oeveren W, Halligan PW. Is there a relationship between cognitive dysfunction and systemic inflammatory response after cardiopulmonary bypass? Ann Thorac Surg 2001;71:667–72. - PubMed
    1. Jensen BO, Hughes P, Rasmussen LS, Pedersen PU, Steinbruchel DA. Cognitive outcomes in elderly high-risk patients after off-pump versus conventional coronary artery bypass grafting: a randomized trial. Circulation 2006;113:2790–5. - PubMed
    1. Abildstrom H, Rasmussen LS, Rentowl P, et al. Cognitive dysfunction 1–2 years after noncardiac surgery in the elderly. Ispocd group. International study of post-operative cognitive dysfunction. Acta Anaesthesiol Scand 2000;44:1246–51. - PubMed

Publication types

MeSH terms