Background and Purpose:
In the operation on the heart diseases, the mortality and the incidence of complication of major cerebrovascular disorders decrease. However, it was reported that the neurocognitive disorders developed frequently after coronary bypass surgery and in the most of them the neurocognitive disorders were restored, but in the part of them the neurocognitive disorders were persist for a long time. On the other hand, there are few reports about the neurocognitive disorders after cardiac valve surgery. In this study, we evaluated the incidence of the neurocognitive disorders after the cardiac valve surgery and the associated risk factor with neurocognitive disorders, and the MRI findings by a multicenter prospective cohort study.
Methods:
A total of 153 patients (95males; mean age, 58.9 years old) who underwent mitral valve surgery between Jun 2004 and March 2006 in 11 institutions were included. MRI imagings were performed before and at 2 weeks, 1 year and 2 years after surgery. The neurocognitive testing were performed before and at 2 weeks, 6 months, 1 year and 2 years after surgery with a neuropsychological test battery that included 9 parameters from 5 tests. Cognitive dysfunction was defined as a 20% reduction in at least 20% of the parameters compared with baseline.
Results:
The number of silent ischemic brain lesions increased by postoperative MRI images in 12 cases of 153 (7.8%). In 26 cases that we could perform T2*-weighted gradient-echo imaging (GRE) before cardiac valve surgery, 19 cases (69%) developed new GRE lesions after cardiac valve surgery. Cognitive dysfunction was identified 74 of 141 cases (52.5%) at 2 weeks and 33 of 120 cases (27.5%) at 2 years after surgery. The ratio of elderly patients 65 years or older was significantly higher in exacerbation group than cognitive function non-exacerbation group (29/74 patinets (39%) vs 15/67 patients (22%), p<0.05).
Conclusion:
The brain damage including the neurocognitive disorder occurs after cardiac valve surgery similar to after coronary bypass surgery. Further examination is necessary about the cause and the clinical significance about the neurocognitive disorder after cardiac valve surgery.
Postoperative atrial fibrillation in patients on statins undergoing isolated cardiac valve surgery: a meta-analysis
