DÄ internationalArchive42/2009Cardiac Surgery in the Elderly Patient: Cognitive Impairments After Bypass Surgery

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Cardiac Surgery in the Elderly Patient: Cognitive Impairments After Bypass Surgery

Dtsch Arztebl Int 2009; 106(42): 693. DOI: 10.3238/arztebl.2009.0693a

Heusinger von Waldegg, G; Klement, A

LNSLNS With regard to the overall results of cardiosurgical interventions and the quality of life of affected patients, postoperative cognitive impairments are enormously important. Substantial impairments to patients’ cognitive functioning are found in the immediate postoperative period as well as in the longer term after the intervention. Newman et al reported early postoperative incidence rates of cognitive impairments of more than 50%, and of 24% even after 6 months after bypass surgery. Impairments to cognitive functioning occurred in elderly people who had no such impairments before the procedure, and deteriorations of cognitive status were noted in patients with pre-existing impairments (1, 2).

While it has been proved that elderly patients benefit from surgical myocardial revascularization with regard to improving cardiac function, Philipps-Bute showed that impairments to neurocognitive functioning as a consequence of cardiac surgery have negative effects on patients’ quality of life in the medium and long term: in 36% of patients, any benefits derived from the improvement in cardiac function are negated by the cognitive deterioration. Interestingly, the use of the heart-lung machine (pump-oxygenator; cardiopulmonary bypass pump) itself does not seem to negatively affect a patient’s neurocognitive status after cardiac surgery. “Off-pump” surgical techniques have not shown measurable risk reductions (2, 3).

The older the patient is in whom surgery is planned, the more important for the overall result it is to consider his or her preoperative comorbidities, especially impairments to cognitive function and to mobility. In the context of the preoperative stratification of risk factors in older patients about to have cardiac surgery, clinically manifest or latent cognitive deficits should be -detected, and timely intervention should be planned for the eventuality of postoperative delirium, so as to reduce postoperative cognitive deterioration in as far as is possible. Older patients with heart disease benefit from an interdisciplinary approach, and the importance of individual comorbidities needs to be balanced, in an interdisciplinary fashion, against quality of life in the long term.
DOI: 10.3238/arztebl.2009.0693a

Dr. med. Gernot Heusinger von Waldegg
Dr. med. Andreas Klement

Dr. med. Gernot Heusinger von Waldegg
Klinik für Geriatrie
Pfeiffersche Stiftungen
Pfeifferstr 10
39114 Magdeburg, Germany
gernot.heusingervonwaldegg@pfeiffersche-stiftungen.org
1.
Newman MF, Kirchner JL, Phillips-Bute B, et al.: Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 2001; 344: 395–402. MEDLINE
2.
Phillips-Bute B, Mathew JP, Blumenthal JA, Grocott HP, Laskowitz DT, Jones RH, Mark DB, Newman MF: Association of neurocognitive function and quality of life 1 year after coronary artery bypass graft (CABG) surgery. Psychosom Med 2006; 68: 369–75. MEDLINE
3.
Jensen BØ, Rasmussen LS, Steinbrüchel DA: Cognitive outcomes in elderly high-risk patients 1 year after off-pump versus on-pump cor¬onary artery bypass grafting. A randomized trial. Circulation. 2006 Jun 20;113(24):2790-5. MEDLINE
4.
Friedrich I, Simm A, Kötting J, Thölen F, Fischer B, Silber RE: Cardiac surgery in the elderly patient [Der alte Patient in der Herzchirurgie]. Dtsch Arztebl Int 2009; 106(25): 416–22. VOLLTEXT
1. Newman MF, Kirchner JL, Phillips-Bute B, et al.: Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 2001; 344: 395–402. MEDLINE
2. Phillips-Bute B, Mathew JP, Blumenthal JA, Grocott HP, Laskowitz DT, Jones RH, Mark DB, Newman MF: Association of neurocognitive function and quality of life 1 year after coronary artery bypass graft (CABG) surgery. Psychosom Med 2006; 68: 369–75. MEDLINE
3. Jensen BØ, Rasmussen LS, Steinbrüchel DA: Cognitive outcomes in elderly high-risk patients 1 year after off-pump versus on-pump cor¬onary artery bypass grafting. A randomized trial. Circulation. 2006 Jun 20;113(24):2790-5. MEDLINE
4. Friedrich I, Simm A, Kötting J, Thölen F, Fischer B, Silber RE: Cardiac surgery in the elderly patient [Der alte Patient in der Herzchirurgie]. Dtsch Arztebl Int 2009; 106(25): 416–22. VOLLTEXT