Original Articles
Early neurobehavioral disorders after cardiac surgery: A comparative analysis of coronary artery bypass graft surgery and valve replacement*,**

https://doi.org/10.1053/jcan.2001.20211Get rights and content

Abstract

Objective: To analyze neurobehavioral disorders in the early postoperative period after valve replacement and coronary artery bypass graft (CABG) surgery. Design: Prospective study. Setting: University hospital. Participants: Patients undergoing elective cardiac surgery with cardiopulmonary bypass; 42 patients in the valve replacement surgery group and 42 patients in the CABG surgery group, with both groups matched post hoc for age, sex, and preoperative cognitive status. Measurements and Main Results: All subjects were investigated preoperatively as well as 2 and 7 days postoperatively with a comprehensive neuropsychologic and neuropsychiatric assessment. The groups did not significantly differ with respect to the incidence of postoperative neuropsychiatric disorders. Valve replacement surgery patients exhibited more severe neuropsychologic deficits and showed a slower recovery than patients who underwent CABG surgery. In both groups, postoperative neuropsychologic alterations were most marked in fluency, arithmetic, and memory performance. Conclusion: These results indicate that patients after valve replacement surgery have a higher risk of postoperative neuropsychologic alterations mainly attributable to temporal lobe dysfunction. This finding corresponds to a specific vulnerability of hippocampal structures to transient hypoxia. Copyright © 2001 by W.B. Saunders Company

Section snippets

Methods

From a consecutive series of 235 patients undergoing elective cardiac surgery at the Department of Heart and Vascular Surgery at Freiburg University or at the Department of Thoracic and Cardiovascular Surgery at Magdeburg University, the preoperative and postoperative neuropsychologic performance of 42 patients undergoing valve replacement were compared with 42 patients undergoing CABG surgery matched by sex, age, and preoperative cognitive status (using the Mini Mental State Examination [MMSE]

Results

Median number of bypass grafts in patients undergoing elective CABG surgery was 3 (range, 2-6). Eighteen patients received an aortic valve replacement; 8 patients, a mitral valve replacement; and 4 patients a combined surgery. In 12 patients, valve replacement was combined with CABG surgery. Table 1 shows the demographic and clinical variables of the patient groups.

. Demographic and Clinical Variables

Empty CellEmpty CellCABGVRp*
No.Empty Cell4242Empty Cell
Sex (female/male)Empty Cell17/2517/25ns
Age (y)†63.563.140-8063.563.637-82ns
Preoperative MMSE†

Discussion

The present data show that patients undergoing valve replacement exhibit more severe neuropsychologic disorders and a significantly prolonged recovery during the postacute stage after surgery. The difference between valve replacement and CABG surgery patients was most marked in learning and memory performance and in a calculation task. Because both samples were matched for sex, age, and preoperative cognitive state, these differences cannot be attributed to the respective sample characteristics.

Acknowledgements

The authors thank V. Schlosser, MD, former Director of the Department of Cardiac and Vascular Surgery, Freiburg University, for allowing access to patients under his care; C.W. Wallesch, MD, Magdeburg University, for helpful comments during study design; and Inka Eisfeld, for support during revision of the manuscript.

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    *

    Supported in part by the Federal Ministry of Education and Research, the State of Saxony-Anhalt, and the State of Baden-Württemberg/Research Program on Neuropsychology and Neurolinguistics.

    **

    Address reprint requests to Manfred Herrmann, MD, PhD, Division of Neuropsychology and Behavioral Neurology, Otto-von-Guericke University, Leipziger Strasse 44, D-39120 Magdeburg, Germany.

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