Risk Factors Associated with Cognitive Decline after Cardiac Surgery: A Systematic Review

Patel, Nikil; Minhas, Jatinder S.; Chung, Emma

doi:10.1155/2015/370612

Cited by 102 publications

(95 citation statements)

References 101 publications

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“…These findings underscore the importance of evaluating cognitive impairment during pre-procedural risk assessment given its association with postoperative delirium and late-onset dementia. 18,27 …”

Section: Discussionmentioning

confidence: 99%

Effect of Cerebral Embolic Protection Devices on CNS Infarction in Surgical Aortic Valve Replacement

Mack

Acker

Gelijns

et al. 2017

JAMA

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IMPORTANCE Stroke is a major complication of surgical aortic valve replacement. OBJECTIVE To determine the effectiveness and safety of cerebral embolic protection devices in reducing ischemic central nervous system injury during surgical aortic valve replacement DESIGN, SETTING and PARTICIPANTS A parallel-group trial conducted in 18 North American centers, randomizing patients with calcific aortic stenosis undergoing surgical aortic valve replacement between March 2015 and July 2016. INTERVENTIONS Use of one of two cerebral embolic protection devices (suction-based extraction;n=118 or intra-aortic filtration device;n=133) versus a standard aortic cannula (n=132) at the time of surgical aortic valve replacement. MAIN OUTCOMES AND MEASURES The primary endpoint was freedom from clinical or radiographic central nervous system (CNS) infarction at 7±3 days post-procedure. Secondary endpoints included a composite of clinical ischemic stroke, acute kidney injury, and death ≤30 days after surgery; delirium; mortality; serious adverse events and neurocognition. RESULTS Among 383 randomized patients (mean age 73.9, 38.4% women), freedom from CNS infarction at 7 days did not differ between suction-based extraction and controls (32.0 vs. 33.3%,difference −1.3,95%CI−13.8, 11.2) nor between intra-aortic filtration and controls (25.6% vs 32.4%, −6.9,95%CI−17.9, 4.2). Clinical stroke occurred in 5.1% suction-based extraction vs 5.8% controls (−0.7, 95%CI −6.5, 5.1) and 8.3% intra-aortic filtration vs. 6.1% controls (2.2, 95%CI −4.1, 8.4). Delirium trajectories (baseline to day 7) differed for suction-based extraction vs. control (p= 0.03) and intra-aortic filtration vs. control (p=0.02); by day 7, 6.3% of suction-based extraction vs 15.3% of control patients (−9.1, 95%CI −17.1, −1.0), and 8.1% of intra-aortic filtration vs 15.6% of control patients (−7.4, 95%CI−15.5, 0.6) experienced delirium. The 30-day composite endpoint did not differ between suction-based extraction and controls (21.4% vs 24.2%; −2.8, 95%CI −13.5,7.9) nor between intra-aortic filtration and controls (33.3% vs 23.7%; 9.7, 95%CI −1.2,20.5). Neurocognitive outcomes were not different between groups except for less decline in executive function in intra-aortic filtration vs controls (p=0.05). CONCLUSIONS AND RELEVANCE The incidence of CNS infarction after surgical aortic valve replacement was not altered by either embolic protection device. Potential benefits for delirium reduction, cognition and symptomatic stroke merit larger trials with longer follow-up.

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Section: Discussionmentioning

confidence: 99%

Effect of Cerebral Embolic Protection Devices on CNS Infarction in Surgical Aortic Valve Replacement

Mack

Acker

Gelijns

et al. 2017

JAMA

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“…We had to increase the dosage of sedatives, analgesics, and muscle relaxants depending upon the actual condition in order to ensure a smooth operation. Many studies have failed to confirm the association between anesthesia and postoperative cognitive dysfunction (POCD), [13][14][15][16][17] and it is also not clear whether high concentration of drugs can cause irreversible brain damage. Negative findings in control group may help us to exclude the effects of anesthesia on experimental results.…”

Section: Discussionmentioning

confidence: 99%

Original Research: Establishment of an early embolus-related cerebral injury model after cardiopulmonary bypass in miniature pigs

Zhang

Weng

et al. 2016

Exp Biol Med (Maywood)

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Embolus-related cerebral injury is still a serious adverse event after cardiopulmonary bypass (CPB). But there is no stable animal model for basic and clinical research purposes. We chose miniature pig to establish a stable animal model of embolus-related cerebral injury after CPB and verified the validity of results by correlating the histopathological findings with those of diffusionweighted magnetic resonance imaging (DW-MRI). Based on different treatment regimens, 24 male miniature pigs were randomly assigned into four groups: Control, CPB, embolus, and CPB-embolus groups. DW-MRI was performed before and after surgery to diagnose and locate the brain lesions. Histopathological changes in brain tissues were examined using H&E and Nissl staining. All surgical procedures were uneventful with 100% postoperative survival of pigs. Two animals in the Embolus group and six animals in the CPB-embolus group showed signs of ischemic penumbra on DW-MRI performed 6 h after surgery. Consistent with the results of DW-MRI, histopathological examination showed necrosis and ischemic lesions. In this paper, we demonstrate the feasibility and validity of a pig model of embolus-related cerebral injury associated with CPB. This model may be used in the future for basic and translational research.

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“…Results cannot be generalized to the oldest-old, to women or to patients with pre-existing cognitive impairments. Postoperative decline appears to be associated with the presence of new ischemic lesions from emboli during surgery, but the pathogenesis seems still unclear and also hard to predict [113]. Claesson et al…”

Section: • Anxiety and Depressionmentioning

confidence: 99%

Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

Angelino

Porta

Abatello

et al. 2018

Monaldi Arch Chest Dis

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Recent guidelines on cardiovascular disease prevention suggest multimodal behavioral interventions for psychosocial risk factors and referral for psychotherapy in the case of clinically significant symptoms of depression and anxiety overall. Accordingly, psychologists of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) have reviewed the key components of psychological activities in cardiovascular prevention and rehabilitation (CPR). The aim of this study was to elaborate a position paper on the best practice in routine psychological activities in CPR based on efficacy, effectiveness and sustainability. The steps followed were: i) a review of the latest international guidelines and position papers; ii) analysis of the evidence-based literature; iii) a qualitative analysis of the psychological services operating in some reference Italian cardiac rehabilitation facilities; iv) classification of the psychological activities in CPR as low or high intensity based on the NICE Guidelines on psychological interventions on anxiety and depression. We confirm the existence of an association between depression, anxiety, social factors, stress, personality and illness onset/outcome and coronary heart disease. Evidence for an association between depression, social factors and disease outcome emerges particularly for chronic heart failure. Some positive psychological variables (e.g., optimism) are associated to illness outcome. Evidence is reported on the impact of psychological activities on 'new' conditions which are now indicated for cardiac rehabilitation: pulmonary hypertension, grown-up congenital heart, end-stage heart failure, implantable cardioverter-defribrillator and mechanical ventricular assist devices, frail and oldest-old patients, and end-of-life care. We also report evidence related to caregivers. The Panel divided evidence-based psychological interventions into: i) low intensity (counseling, psycho-education, self-care, self-management, telemedicine, self-help); or ii) high intensity (individual, couples and/or family and group psychotherapy, such as stress management). The results show that psychotherapy is mainly consisting of cognitive-behavior therapy, interpersonal therapy, and short-term psycho-dynamic therapy. The current data further refine the working tools available for psychological activities in CPR, giving clear directions about the choice of interventions, which should be evidence-based and have at least a minimum standard. This document provides a comprehensive update on new knowledge and new paths for psychologists working in the CPR settings.

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Risk Factors Associated with Cognitive Decline after Cardiac Surgery: A Systematic Review

Cited by 102 publications

References 101 publications

Effect of Cerebral Embolic Protection Devices on CNS Infarction in Surgical Aortic Valve Replacement

Effect of Cerebral Embolic Protection Devices on CNS Infarction in Surgical Aortic Valve Replacement

Original Research: Establishment of an early embolus-related cerebral injury model after cardiopulmonary bypass in miniature pigs

Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

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