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Short-term and long-term neuropsychological consequences of cardiac surgery with extracorporeal circulation
- Source :
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 11(3)
- Publication Year :
- 1997
-
Abstract
- Objecti6e: Cognitive dysfunction after extracorporeal circulation is a major continuing problem in modern cardiac surgery. We designed this prospective study to update the incidence of postoperative neuropsychological changes after routine cardiopulmonary bypass (CPB) and to identify perioperative variables associated with these complications. Methods: We assessed the patients with a comprehensive neuropsychological test battery 1 day before, 7 days after (n 109) and 6 months after (n91) cardiopulmonary bypass. We used patients undergoing major vascular or thoracic surgery as a surgical control group (n20). Results: Repeated measures multivariate analysis of variance (using surgical group as a between-subjects factor) on the group data revealed significant changes early after surgery compared with the preoperative performance (P 0.001). The early changes are characterized by a significant decrease of visual attention and verbal memory performance (univariate F-tests, always PB0.05). Cardiac patients showing cognitive impairment after cardiac surgery had lower preoperative ejection fractions (P 0.014) and a more complicated medical history (P0.046). At 6-month follow-up, the patients performed significantly better than before surgery (PB0.001). CPB patients showing persistent cognitive impairment at follow-up were significantly older at the time of surgery (P0.005). Individual comparisons revealed that 45% of the patients undergoing CPB showed evidence of cognitive impairment soon after surgery. In 12% of the patients, the cognitive sequelae persisted at follow-up. Both group data and individual incidence rates revealed neither significant preāpost differences between the surgical groups nor a time-by-group interaction effect. Variables directly associated with CPB were not significantly associated with the occurrence of cognitive impairment after surgery. Conclusions: We conclude that an important proportion of the cognitive impairment after cardiac surgery is likely to be due to nonspecific effects of surgery. © 1997 Elsevier Science B.V.
- Subjects :
- Pulmonary and Respiratory Medicine
Adult
Male
medicine.medical_specialty
Extracorporeal Circulation
Heart Diseases
Neuropsychological Tests
law.invention
Postoperative Complications
law
Risk Factors
medicine
Cardiopulmonary bypass
Humans
Prospective Studies
Aged
Ejection fraction
medicine.diagnostic_test
business.industry
Cognitive disorder
Extracorporeal circulation
General Medicine
Neuropsychological test
Perioperative
Middle Aged
medicine.disease
Cardiac surgery
Cardiothoracic surgery
Anesthesia
Surgery
Brain Damage, Chronic
Female
Cardiology and Cardiovascular Medicine
business
Cognition Disorders
Follow-Up Studies
Subjects
Details
- ISSN :
- 10107940
- Volume :
- 11
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
- Accession number :
- edsair.doi.dedup.....25e643a62b8fcf99cdf96f3d40c98680