Cognitive Outcomes 7.5 Years After Angioplasty Compared With Off-Pump Coronary Bypass Surgery

Sauër, Anne-Mette C.; Nathoe, Hendrik M.; Hendrikse, Jeroen; Peelen, Linda M.; Regieli, Jakub J.; Veldhuijzen, Dieuwke S.; Kalkman, Cor J.; Grobbee, Diederick E.; Doevendans, Pieter A.; Dijk, Diederik van

doi:10.1016/j.athoracsur.2013.05.001

Cited by 37 publications

(39 citation statements)

References 17 publications

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“…A number of high-profile studies have credibly demonstrated that neither on-pump nor offpump are associated with a higher risk of cognitive decline when compared to medical or non-surgical treatments [30]. In fact, Sauer et al, recently reported a trend towards lower cognitive performance in the Percutaneous Coronary Intervention group when compared to CABG [15]. Bruce et al, confirmed these results [17].…”

Section: Poci As a Likely Effect Of The Surgerysupporting

confidence: 72%

“…Several investigations compared cognitive changes in patients who had surgery with versus without extracorporeal circulation ("off-pump") and found no difference in outcomes [13,14]. Similarly, there is no difference in cognitive outcome in patients treated with angioplasty versus off-pump coronary bypass surgery [15]. A number of publications by Selnes et al have convincingly demonstrated that although subjective memory complaints are more frequent in the early postoperative period, there is no measurable long-term cognitive changes [16].…”

Section: Review Of the Studies That Do Not Demonstrate Pocd After Carmentioning

confidence: 99%

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Long-Term Cognitive Decline in the Elderly is not Attributable to Surgery/Anesthesia

Bekker¹,

Korban²

2017

IJAR

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Postoperative cognitive dysfunction (POCD) is a topic of special importance for elderly patients. Based upon the results of a combination of retrospective human studies, experiments in animals, and a number of prospective human studies, the anesthesia research community has advanced the notion that surgery/anesthesia might precipitate permanent incident dementia. A careful analysis of the data, however, reveals numerous methodological problems with the clinical trials that have examined long-term POCD, including the vague definition of POCD, poorly matched controls (or lack of controls in some investigations), arbitrary diagnostic criteria, etc. More recent evidence suggests that the vast majority of patients without pre-existing disease recover cognition in the long term. In fact, there are studies that suggest that in some cases surgery improves cognitive functioning (e.g. carotid endarterectomy, weight reduction surgery, etc.). This report critically analyzes the methodological concerns of the older studies and presents current evidence rejecting the long-term POCD hypothesis. In addition, it reviews the pre-existing conditions that may result in long term POCD. 491 OPEN ACCESShttps://scidoc.org/IJAR.php

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Section: Poci As a Likely Effect Of The Surgerysupporting

confidence: 72%

Section: Review Of the Studies That Do Not Demonstrate Pocd After Carmentioning

confidence: 99%

Long-Term Cognitive Decline in the Elderly is not Attributable to Surgery/Anesthesia

Bekker¹,

Korban²

2017

IJAR

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“…This view is challenged, however, by data from Selnes and McKann et al, who found no difference in the long term cognitive trajectory (at 3 or 6 years after surgery) in patients with coronary artery disease (CAD) who underwent cardiac surgery versus control patients with CAD who did not undergo cardiac surgery (8,29,30). Similarly, CAD patients who underwent off-pump CABG had similar cognitive outcomes as CAD patients who underwent percutaneous coronary intervention (31). Thus, there is clearly long term cognitive decline that occurs over years in older patients with CAD, but this long term decline appears to be largely due to patient factors (such as pre-existing neurovascular disease) rather than procedural factors (such as cardiac surgery, cardiopulmonary bypass, or anesthesia itself, (32)).…”

Section: A Description Of Pocd and Pocimentioning

confidence: 99%

Postoperative Cognitive Dysfunction

Berger

Nadler

Browndyke

et al. 2015

Anesthesiology Clinics

223

119

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Ever since Bedford’s seminal Lancet case series in 1955, we have known that perioperative care is sometimes followed by significant cognitive dysfunction (1). Although the safety of perioperative care has improved dramatically since 1955, the descriptions of cognitive dysfunction in that case series are eerily similar to the complaints of current patients suffering from post-operative cognitive dysfunction (POCD). POCD remains a common post-operative complication associated with significant morbidity and even mortality, especially among elderly patients. There has been a great deal of interest in and controversy about POCD, from how it is measured, to how long it lasts, to its precise implications for patients. This interest and controversy is reflected partly in the increasing number of papers published on this subject recently (shown in Figure 1). Recent work has also suggested surgery may be associated with cognitive improvement in some patients (2–4), termed Post-Operative Cognitive Improvement (POCI). As the number of surgeries performed worldwide approaches 250 million per year (5) (with an increasing number elderly patients), optimizing postoperative cognitive function and preventing/treating POCD are major public health issues. In this article we review the literature on POCD and POCI, and discuss current research challenges in this area.

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“…Un estudio comparativo a los 7,5 años de seguimiento en pacientes con injerto de bypass arterial coronario sin bomba tuvieron un rendimiento cognitivo similar o tal vez incluso mejor en comparación con los pacientes con intervención coronaria percutánea (18); lo que sugeriría que el procedimiento y la anestesia por si mismo podrían no ser condicionantes de DCPO. Un estudio en gemelos en donde se evaluó a largo plazo la asociación entre la exposición a ciruigía y el funcionamiento cognitivo encontró que el funcionamiento cognitivo preoperatorio y las enfermedades subyacentes eran más importantes para el funcionamiento cognitivo en la vida media y tardía que la cirugía y la anestesia (19 Asimismo existen otras entidades clínicas que aumentan el riesgo de complicaciones post operatorias como la fragilidad, un síndrome asociado a la edad, con mayor vulnerabilidad fisiológica de múltiples órganos y sistemas y mayor riesgo de resultados adversos para la salud, por disminución de la reserva fisiológica y problemas de los mecanismos homeostáticos, por alteraciones a nivel neuromuscular, metabólico, del sistema inmune con menor adaptación a factores adversos (20)(21)(22); así como la sarcopenia que es la pérdida de la masa muscular, de la fuerza y de la función del musculo esquelético, directamente asociada al envejecimiento y que puede ser primaria, secundaria, asociada a otras enfermedades o a trastornos nutricionales (23,24).…”

Section: Factores De Riesgounclassified

Una complicación quirúrgica escasamente sospechada: la disfunción cognitiva postoperatoria

Lira¹,

Mar-Meza²,

Montesinos³

et al. 2018

Rev Neuropsiquiatr

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RESUMENNumerosas enfermedades requieren como tratamiento una cirugía, ya sea de emergencia o electiva. Las cirugías pueden tener diversas complicaciones; sin embargo no se consideran las posibles alteraciones cognitivas postoperatorias: delirio del despertar anestésico, delirio postoperatorio y disfunción cognitiva postoperatoria (DCPO). La DCPO es un síndrome clínico caracterizado por alteraciones en la memoria, concentración, atención, comprensión del lenguaje e integración social posterior al uso de anestesia y cirugía que persiste después de tres meses; aunque algunos reportes consideran que no sería una entidad clínica individual. Su incidencia varía del 5,1 al 52,5% dependiendo de la población estudiada, tipo de cirugía, tiempo de la evaluación desde la cirugía y batería neuropsicológica empleada. Los factores de riesgo para DCPO son: edad avanzada, deterioro cognitivo previo, gravedad de enfermedades coexistentes, severidad de la cirugía, duración y tipo de la anestesia, ocurrencia de complicaciones y nivel educativo; siendo imprescindible la realización de una evaluación neuropsicológica antes y después de la cirugía para su diagnóstico. Los mecanismos etiopatogénicos propuestos son: la edad, cambios en la perfusión cerebral, disturbios del sueño, inflamación, efectos de los agentes anestésicos, y fundamentalmente la neuroinflamación. La DCPO es una entidad frecuente y escasamente sospechada, aunque su diagnóstico es controversial. Se sugiere que los pacientes que serán sometidos a cirugías electivas mayores, en especial las cardiacas y cerebrales, sean sometidos a evaluación neuropsicológica previa y a los 3 meses, así como a monitoreo electroencefalográfico intraoperatorio para disminuir la incidencia de DCPO.PALABRAS CLAVE: Deterioro cognitivo, disfunción cognitiva postoperatoria, complicación quirúrgica, pérdida de la memoria.

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Cognitive Outcomes 7.5 Years After Angioplasty Compared With Off-Pump Coronary Bypass Surgery

Cited by 37 publications

References 17 publications

Long-Term Cognitive Decline in the Elderly is not Attributable to Surgery/Anesthesia

Long-Term Cognitive Decline in the Elderly is not Attributable to Surgery/Anesthesia

Postoperative Cognitive Dysfunction

Una complicación quirúrgica escasamente sospechada: la disfunción cognitiva postoperatoria

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