Heart Surgery and a Decline in Mental Function: Are the two related?
Every patient strives to return to his or her regular level of function after heart surgery. Concerns about their mental function after heart surgery is a common question among patients facing a much needed surgery. Memory loss and mood changes are some manifestations of what doctors refer to as "neurocognitive dysfunction."
Two papers published in the December 2007 issue of Annals of Thoracic Surgery address these particular problems facing patients with heart disease. The first paper by the Johns Hopkins University compared changes in neurocognitive performance in patient with heart disease who underwent heart surgery with those who were managed without heart surgery. Although reduced mental function is observed in patients with heart disease, this reduction was not related to whether patients underwent heart surgery. In other words, patients with heart disease manifest the same reduction in mental function whether they underwent heart surgery or not.
Nevertheless, a loss of mental function remains a major concern to patients and physicians alike. It was hoped that new technology such as the "off-pump" coronary artery bypass would reduce the risk of neurocognitive dysfunction by avoiding the use of the heart-lung machine. The second paper from Dartmouth compared neurocognitive performance in patients having standard coronary artery bypass surgery with patients having the off-pump coronary artery bypass surgery. This study showed that patients having the standard coronary artery bypass surgery fared no worse than patients having the off-pump surgery.
S. Chris Malaisrie, MD, cardiothoracic surgeon at the Bluhm Cardiovascular Institute states, "Fortunately, patients who do experience neurocognitive dysfunction following their heart surgery can expect their symptoms to resolve over a period of weeks to months. For the majority of patients, these deficits are temporary and should not affect a healthy recovery." Dr. Malaisrie is the co-director of the Thoracic Aortic Surgery program at the Bluhm Cardiovascular Institute, assistant professor at Northwestern University Feinberg School of Medicine, and a member of the Northwestern Medical Faculty Foundation.
Hernandez, F., Jr., J. R. Brown, et al. (2007). "Neurocognitive outcomes of off-pump versus on-pump coronary artery bypass: a prospective randomized controlled trial." Ann Thorac Surg 84(6): 1897-903.
Selnes, O. A., M. A. Grega, et al. (2007). "Neurocognitive outcomes 3 years after coronary artery bypass graft surgery: a controlled study." Ann Thorac Surg 84(6): 1885-96.