New study reinforces need for proactive cognitive monitoring after heart surgery

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Heart surgery: Does it impact cog­ni­tive abil­i­ty? (Med­ical News Today):

“Almost 8 mil­lion peo­ple in the Unit­ed States under­go car­dio­vas­cu­lar surgery or oth­er relat­ed pro­ce­dures each year.

Thanks to the steady improve­ments made by med­ical sci­ence, the pro­ce­dures are becom­ing ever safer and can give peo­ple a new lease of life.

Aware of improve­ments in phys­i­cal health due to car­dio­vas­cu­lar surgery, sci­en­tists know less about the cog­ni­tive impact of open heart surgery.

A recent study set out to under­stand pre­cise­ly how heart surgery might influ­ence the mind … Over­all, the researchers con­clude that indi­vid­u­als who under­go heart valve surgery are like­ly to have reduced cog­ni­tive abil­i­ty for the first few months after the procedure.

Although men­tal abil­i­ty is like­ly to return to nor­mal with­in 6 months, this is a mat­ter for fur­ther research. The authors of the study note this as one of the study’s short­falls — they did not inves­ti­gate cog­ni­tive per­for­mance past the 6‑month point…

The authors hope that their find­ings “encour­age rou­tine pre­op­er­a­tive cog­ni­tive assess­ment to estab­lish cog­ni­tive base­line and post­op­er­a­tive assess­ment to mon­i­tor trajectory.”

Accord­ing to the authors, it would be use­ful if future stud­ies focused on the spe­cif­ic fac­tors that made valve surgery patients more sus­cep­ti­ble to cog­ni­tive decline. This could guide clin­i­cians as they help patients and their fam­i­lies through the recov­ery process.”

The Study:

Cog­ni­tive Out­comes After Heart Valve Surgery: A Sys­tem­at­ic Review and Meta?Analysis (Jour­nal of the Amer­i­can Geri­atrics Soci­ety). From the 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.
  • 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.

The Study in Context: