Long-Term Neurocognitive Function After Mechanical Aortic Valve Replacement

• Published in: The Annals of thoracic surgery Vol. 81; no. 1; pp. 29 - 33
• Main Authors: Zimpfer, Daniel, Czerny, Martin, Schuch, Philipp, Fakin, Richard, Madl, Christian, Wolner, Ernst, Grimm, Michael
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2006; Elsevier Science
• Subjects: Adult; Aged; Anticoagulants - therapeutic use; Aortic Valve - surgery; Atrial Fibrillation - complications; Atrial Fibrillation - epidemiology; Biological and medical sciences; Cognition Disorders - diagnosis; Cognition Disorders - epidemiology; Cognition Disorders - etiology; Cognition Disorders - psychology; Cohort Studies; Event-Related Potentials, P300; Female; Follow-Up Studies; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation; Humans; Intracranial Embolism - epidemiology; Intracranial Embolism - etiology; Intracranial Embolism - psychology; Male; Medical sciences; Middle Aged; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - psychology; Prospective Studies; Reaction Time; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Treatment Outcome; 35; Treatment; Respiratory disease; Surgery; Cognition; Replacement; Thorax; Long term; Aortic valve
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2005.06.039

Mechanical aortic valves are a possible source of microemboli potentially causing cerebral injury. Therefore, the long-term impact of mechanical aortic valve replacement on neurocognitive function is uncertain.
In this prospective, contemporary study, we followed 32 consecutive patients (aged 51 ± 8 years; range, 38 to 70; EuroSCORE [European System for Cardiac Operative Risk Evaluation] 4.4 ± 1.7) undergoing isolated aortic valve replacement with a mechanical prosthesis. A cohort of age- and sex-matched patients (n = 28, aged 50 ± 7 years) served as nonsurgical controls. After aortic valve replacement, neurocognitive function was serially reevaluated at 7-day (n = 32), 4-month (n = 31), and 3-year (n = 29) follow-up. Neurocognitive function was measured by means of P300 auditory evoked potentials.
Before the operation, P300 peak latencies were comparable between surgical patients (361 ± 32 ms) and nonsurgical controls (365 ± 33 ms,
p = 0.783). In patients undergoing aortic valve replacement, P300 peak latencies were prolonged 7 days after surgery (380 ± 32 ms) as compared with before the operation (361 ± 32 ms,
p < 0.0001) and as compared with nonsurgical controls (364 ± 34 ms,
p = 0.002). At 4-month (369 ± 30 ms,
p = 0.752) and 3-year (370 ± 31 ms,
p = 0.825) follow-up, P300 peak latencies normalized as compared with before operation and as compared with nonsurgical controls (4-month follow-up 363 ± 31 ms,
p = 0.832; 3-year follow-up 366 ± 32 ms,
p = 0.432). We found no difference in patients with different valve types.
Despite previous assumptions based on the potential occurence of microemboli in patients with mechanical valves, mechanical aortic valve replacement has no adverse long-term impact on neurocognitive function. This finding is only valid for patients with a comparable age range undergoing isolated aortic valve replacement.