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Prediction of cognitive dysfunction and patients' outcome following valvular heart surgery and the role of cerebral oximetry.

Authors
 Seong Wook Hong  ;  Jae Kwang Shim  ;  Yong Seon Choi  ;  Dae Hee Kim  ;  Byung Chul Chang  ;  Young Lan Kwak 
Citation
 EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol.33(4) : 560-565, 2008 
Journal Title
 EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY 
ISSN
 1010-7940 
Issue Date
2008
MeSH
Body Temperature/physiology ; Brain/metabolism* ; Cerebrovascular Circulation/physiology* ; Cognition Disorders/diagnosis* ; Cognition Disorders/etiology ; Cognition Disorders/psychology ; Coronary Artery Bypass/methods ; Coronary Artery Bypass/rehabilitation ; Educational Status ; Female ; Heart Valve Diseases/surgery* ; Heart Valves/physiopathology ; Heart Valves/surgery ; Humans ; Male ; Middle Aged ; Monitoring, Intraoperative/methods ; Neuropsychological Tests/standards ; Oximetry/methods* ; Oxygen/metabolism* ; Postoperative Care/methods ; Predictive Value of Tests ; Spectroscopy, Near-Infrared/methods ; Treatment Outcome
Keywords
Valvular heart surgery ; Cognitive dysfunction ; Cerebral oximetry
Abstract
OBJECTIVE: Postoperative cognitive dysfunction (POCD) commonly develops after cardiac surgery affecting patients' outcome. Cerebral oximetry noninvasively measures regional cerebral oxygen saturation (rSO(2)) and significant correlation has been reported between intraoperative cerebral desaturation and POCD, as well as patients' outcome following coronary artery bypass grafting. However, evidence is limited in valvular heart surgery (VHS). We investigated the relationship of intraoperative rSO(2) values with POCD and length of postoperative hospitalization in patients undergoing VHS. METHODS: One hundred patients undergoing elective VHS were enrolled. Neurocognitive evaluation was performed with Mini-Mental State Examination, Trail-Making Test (Part A), and Grooved Pegboard Test at 1 day before and 7th day after surgery. During surgery, rSO(2) was continuously monitored and the incidence and duration of decrease in rSO(2) values for five consecutive minutes were recorded as follows; (1) decrease in absolute rSO(2) values to less than 50%, (2) 40%, and (3) a 20% decrease compared to baseline value. RESULTS: Twenty-three patients (23%) demonstrated POCD. We could not observe any significant differences in either the incidence or duration of decrease in rSO(2) values between patients with and without POCD. Low education level and higher baseline temperature had significant correlation with POCD. Patients with cerebral desaturation required significantly longer postoperative hospitalization. CONCLUSION: In patients undergoing VHS, POCD could not be predicted with cerebral oximetry. However, patients with intraoperative cerebral desaturation required significantly longer postoperative hospitalization and cerebral oximetry appears to be promising in terms of monitoring the brain as the index organ for systemic perfusion and improving patients' outcome.
Full Text
http://ejcts.oxfordjournals.org/content/33/4/560.long
DOI
10.1016/j.ejcts.2008.01.012
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Chang, Byung Chul(장병철)
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
Hong, Seong Wook(홍성욱)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/106160
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