Abstract 2063: Longitudinal Follow-up Of Cognitive Function After Cardiac Valve Replacement: A Three-Year Prospective Study
Background: Adverse neurocognitive outcome has been a continuing challenge to modern cardiac surgery. Cardiac valve replacement implies a high risk of neuronal injury. However, long-term studies of cognitive function do not exist until now. We aimed to assess the course of cognitive performance during 3 years after cardiac valve surgery and to identify factors that may predict long-term outcome.
Methods: A total of 30 patients (64.9±9.8 yrs.) undergoing elective isolated heart valve replacement as the first time cardiac operation were prospectively investigated preoperatively, at discharge, 3 months and 3 years after surgery. Neuropsychological performance was evaluated with a battery of 11 standardized psychometric tests measuring seven cognitive domains (psychomotor speed, executive function, attention, verbal memory, visual memory, logical thinking, visuoconstruction). High-resolution multi-sequence magnetic resonance imaging (MRI) including diffusion-weighted technique was performed to detect cerebral ischemia.
Results: Cognitive deficits (drop of ≥1 standard deviation in scores in ≥3 tests) were present in 15/30 patients (50%) at discharge, 2/30 patients (7%) at 3 months, and 4/25 patients (16%) at 3 years compared to baseline, respectively. Both patients with a deficit at 3 months behaved normal at discharge, and none of the patients had a persistent deficit. Postoperative MRI disclosed 41 new focal ischemic brain lesions in 47% of patients (1–7 lesions/patient; lesion volume 91–745 mm3). All lesions were neurologically silent. None of the variables tested by stepwise regression analyses including medical history data, operative factors, preexisting or new postoperative ischemic lesions on MRI, postoperative adverse events or type of prosthesis were found to predict late cognitive decline.
Conclusions: Cognitive decline after cardiac valve replacement is benign and frequently resolves within weeks. The few cognitive deficits that were found years later are most likely related to factors other than the operation itself.