Document Detail


Risk factors for neurocognitive dysfunction after cardiac surgery in postmenopausal women.
MedLine Citation:
PMID:  18640325     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Women are at higher risk than men for neurologic complications from cardiac operations. This study identified risk factors for neurocognitive dysfunction after cardiac operations in elderly women.
METHODS: One hundred thirteen postmenopausal women undergoing primary coronary artery bypass grafting, with or without valve operation, underwent psychometric testing and neurologic evaluation the day before operation and 4 to 6 weeks postoperatively. Risk factors assessed for neurologic complications included atherosclerosis of the ascending aorta and apolipoprotein epsilon4 genotype. Postoperative neurocognitive dysfunction was defined as the composite end point of a one standard deviation decrement from baseline on two or more psychometric tests or a new neurologic deficit.
RESULTS: Neurocognitive dysfunction was present in 25% of the women 4 to 6 weeks postoperatively. Women with a neurocognitive deficit tended to be older than those without a deficit (72.1 +/- 8.1 vs 69.4 +/- 8.9 years, p = 0.144) and were more likely to have mild atherosclerosis of the ascending aorta, a history of congestive heart failure, longer duration of cardiopulmonary bypass (CPB) and aortic cross-clamping, lower nadir blood pressure during CPB, higher rates of postoperative atrial fibrillation, and longer postoperative hospitalization. Mild atherosclerosis of the ascending aorta, duration of CPB, duration of aortic cross-clamping (p = 0.051), and length of postsurgical hospitalization were independently associated with postoperative neurocognitive dysfunction.
CONCLUSIONS: Mild atherosclerosis of the ascending aorta, duration of CPB, aortic cross-clamping time, and length of hospitalization, but not apolipoprotein epsilon4 genotype, identified risk for neurocognitive dysfunction after cardiac operation in postmenopausal women.
Authors:
Charles W Hogue; Robert Fucetola; Tamara Hershey; Kenneth Freedland; Victor G Dávila-Román; Alison M Goate; Richard E Thompson
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  86     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-21     Completed Date:  2008-09-03     Revised Date:  2013-06-14    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  511-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. chogue2@jhmi.edu
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00123539
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Diseases / epidemiology
Apolipoproteins A / genetics
Cardiopulmonary Bypass
Cognition Disorders / epidemiology*
Coronary Artery Bypass / adverse effects*
Coronary Artery Disease / epidemiology
Coronary Disease / surgery
Female
Humans
Length of Stay
Logistic Models
Middle Aged
Postoperative Complications / epidemiology
Risk Factors
Grant Support
ID/Acronym/Agency:
AG05681/AG/NIA NIH HHS; R01 64600//PHS HHS; R01 HL064600/HL/NHLBI NIH HHS; R01 HL064600-06/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Apolipoproteins A; 0/apolipoprotein A-IV
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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