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Postoperative cognive dysfunctions after cardiac operations

Postoperative cognive dysfunctions after cardiac operations. Alina Borkowska, Wojciech Pawliszak, Krzysztof Szwed, Lech Anisimowicz. Chair and Department of Clinical Neuropsychology Cardiosurgery Clinic Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Poland.

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Postoperative cognive dysfunctions after cardiac operations

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  1. Postoperative cognive dysfunctions after cardiac operations Alina Borkowska, Wojciech Pawliszak, Krzysztof Szwed, Lech Anisimowicz Chair and Department of Clinical Neuropsychology Cardiosurgery Clinic Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Poland

  2. Cardiac operations and CNS 1965 r. - S Tufo – first statistical eveluation of the prevalence of stroke after cardiac operation (6%) 1970 r. – T. Aberg – first information of psychiatric and psychological complications after cardiac operations with on-pump procedure – the prevalence of neuropsychiatric consequences of these operations about 80%

  3. Possiblereasons of neuropsychiatricscomplicationsaftercardiacoperations • microembolisation • hypoxia • hypoperfussion • hypotermy • inflammatoryreactions, brainedema • oxydativestress • bloodpressurechanges • brainbloodflowdisturbances • anaesthesia Impairment of cellsmetabolism impairment of neuronsstructure and functions Abnormalities of brainstructuressynchronization (Newman i wsp., 2001; 2006 Dong-Liang-Mu i wsp., 2013; Sirvinskas i wsp., 2014)

  4. Neuropsychiatriccomplicationsaftercoronaryaftery bypass grafting CABG) • Brain impairmentvisible in neuroimagin and neuropathologyevaluation • Coma • Stroke • Amnesia (TIA) • Postoperativecognitivedysfunctions (POCD)

  5. Neuropsychiatriccomplicationsaftercardiosurgeryinterventions • Early and late neuropsychiatric disturbances may have occurs in more than half (30-80%) patients after cardiosurgery interventions • There is still a problem with a diagnosis and treatment of postoperative cognitive dysfunctions (POCD) • Type of cardiac operations are important to the CNS functioning • Operations with pump circulations are associated with higher risk of CNS impairment

  6. Postoperativecognitivedysfunctions • POCD are associated with : • Worsening of patient quality of life • Prolonged time of hospitalization • Higer risk of psychosocial functioning dificulties • Higher risk of depression and persistent cognitive decline • Higher costs of medical care(Phillips-Bute et al. 2006; Stroobant et al. 2010; Ito et al, 2012).

  7. On pump and off pump procedure Higher risk of CNS impairment Lower risk of CNS impairment

  8. „Traditional” and „no touch” off pump coronaryartery bypass grafting OPCABG „no touch” vs „traditional” OPCABG

  9. Depression and POCD and cortisollevelafter OPCABG Higher cortisol level in the first morning after operations associated with: • Higher early POCD development (7 days) • Higher depression rate after postoperative period • Dong-Liang Mu i wsp., 2013

  10. The results p = 0,047

  11. POCD after „traditional” vs. „no touch” OPCABG Szwed i wsp. World Journal of Biol Psychiatry 2013

  12. SYNTAX score (aorta stiffnessmeasurement) • The Syntax score was recently developed as a comprehensive, angiographic tool grading the complexity of coronary artery disease.

  13. SYNTAX score • SYNTAX score may be an indirect indicator of the degree of atherosclerosisin vascular zones that are particularly important in the etiology of POCD (i.e. cerebral arteries and ascending aorta).

  14. Neuropsychological Evaluation • Evaluation at the time of admission (7±2 days preoperatively) and discharge (7 days postoperatively) • POCD – a decline from preoperative performance of more than 20% on two or more tests

  15. The results

  16. Conclusions • No touch CABG operationsaremoresafe for CNS compared to the traditionalones • Lower level of cognitivefunctionsimpairment • Less dysfunctionalareas • Syntaxscoreisanusefulmeasurement of POCD predictions • To prevent of POCD importantare: • Monitoring of adverseeventsduring the operation • Properdiagnosis and treatment of POCD

  17. Alina Borkowska Maciej Bieliński Krzysztof Szwed Martyna Gębska Marta Tomaszewska Gosia Piskunowicz Joanna Ulfig Iwona Miklasz Lech Anisimowicz Wojtek Pawliszak

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