Mark A Oldham1, Jacqueline Vachon2, David Yuh3, Hochang B Lee1. 1. Department of Psychiatry, University of Rochester Medical Center, Rochester, New York. 2. Oncology Department, Ingram School of Nursing, McGill University, Montréal, Quebec, Canada. 3. Department of Surgery, Stamford Hospital, Stamford, Connecticut.
Abstract
OBJECTIVES: To summarize evidence on cognitive outcomes after heart valve surgery; secondary aim, to examine whether aortic and mitral valve surgery are associated with different cognitive outcomes. DESIGN: Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review and meta-analysis. SETTING: Cardiac surgery. PARTICIPANTS: Individuals undergoing heart valve surgery. MEASUREMENTS: We searched MEDLINE, EMBASE, and PsycINFO for peer-reviewed reports of individuals undergoing heart valve surgery who underwent pre- and postoperative cognitive assessment. Our initial search returned 1,475 articles, of which 12 were included. Postoperative cognitive results were divided into those from 1 week to 1 month (early outcomes, npooled = 450) and from 2 to 6 months (intermediate outcomes; npooled = 722). No studies with longer-term outcomes were identified. RESULTS: Subjects had moderate early cognitive decline from baseline (Becker mean gain effect size (ES)=-0.39 ± 0.27) that improved slightly by 2 to 6 months (ES=-0.25 ± 0.38). Individuals undergoing aortic valve surgery-who were older on average than those undergoing mitral valve surgery (68 vs 57)-had greater early cognitive decline than those undergoing mitral valve surgery (ES=-0.68 vs -0.12), but both cohorts had similar decline 2 to 6 months postoperatively (ES=-0.27 vs -0.20). CONCLUSIONS: Heart valve surgery is associated with cognitive decline over the 6 months after surgery, but outcomes beyond 6 months are unclear. These findings highlight the cognitive vulnerability of this population, especially older adults with aortic stenosis.
OBJECTIVES: To summarize evidence on cognitive outcomes after heart valve surgery; secondary aim, to examine whether aortic and mitral valve surgery are associated with different cognitive outcomes. DESIGN: Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review and meta-analysis. SETTING: Cardiac surgery. PARTICIPANTS: Individuals undergoing heart valve surgery. MEASUREMENTS: We searched MEDLINE, EMBASE, and PsycINFO for peer-reviewed reports of individuals undergoing heart valve surgery who underwent pre- and postoperative cognitive assessment. Our initial search returned 1,475 articles, of which 12 were included. Postoperative cognitive results were divided into those from 1 week to 1 month (early outcomes, npooled = 450) and from 2 to 6 months (intermediate outcomes; npooled = 722). No studies with longer-term outcomes were identified. RESULTS: Subjects had moderate early cognitive decline from baseline (Becker mean gain effect size (ES)=-0.39 ± 0.27) that improved slightly by 2 to 6 months (ES=-0.25 ± 0.38). Individuals undergoing aortic valve surgery-who were older on average than those undergoing mitral valve surgery (68 vs 57)-had greater early cognitive decline than those undergoing mitral valve surgery (ES=-0.68 vs -0.12), but both cohorts had similar decline 2 to 6 months postoperatively (ES=-0.27 vs -0.20). CONCLUSIONS: Heart valve surgery is associated with cognitive decline over the 6 months after surgery, but outcomes beyond 6 months are unclear. These findings highlight the cognitive vulnerability of this population, especially older adults with aortic stenosis.
Authors: Maisha M Khan; Krista L Lanctôt; Stephen E Fremes; Harindra C Wijeysundera; Sam Radhakrishnan; Damien Gallagher; Dov Gandell; Megan C Brenkel; Elias L Hazan; Natalia G Docteur; Nathan Herrmann Journal: Clin Interv Aging Date: 2019-05-08 Impact factor: 4.458
Authors: María Correa-Rodríguez; Moath Abu Ejheisheh; Nora Suleiman-Martos; María José Membrive-Jiménez; Almudena Velando-Soriano; Jacqueline Schmidt-RioValle; José Luis Gómez-Urquiza Journal: J Clin Med Date: 2020-03-26 Impact factor: 4.241