Neuropsychological indicators of postoperative cognitive dysfunctions after off-pump coronary artery bypass grafting

V.V.  Antonenko; S.O.  Dubrov

doi:10.26641/2307-0404.2025.1.325365

Authors

V.V. Antonenko SI “National scientific center of surgery and transplantation named after O.O. Shalimov to National Academy of Medical Sciences of Ukraine”, Academician Shalimov str., 30, Kyiv, 03126; Bogomolets National Medical University, Beresteiskyi ave., 34, Kyiv, 01601, Ukraine https://orcid.org/0000-0003-2395-4563
S.O. Dubrov Bogomolets National Medical University, Beresteiskyi ave., 34, Kyiv, 01601, Ukraine https://orcid.org/0000-0002-2471-3377

DOI:

https://doi.org/10.26641/2307-0404.2025.1.325365

Keywords:

cognitive dysfunctions, off-pump coronary artery bypass, neurocognitive testing, general anesthesia

Abstract

The problem of postoperative cognitive dysfunctions (POCD) becomes more significant with the increase in frequency and expansion of operations in cardiac surgery practice. It’s one of the common clinical complications following anesthesiologic support in cardiac surgery, which can change in a long-term period. POCD is a decrease of cognitive functions after surgery and general anesthesia from the baseline preoperative level. It’s characterized by impairment of attention, concentration, memory, learning and processing of information, verbal, visual and visuospatial deficits. The attention of anesthesiologists and specialists in related specialties is attracted by the medical and social consequences of cognitive disorders, which have a negative impact on the duration of hospitalization, its cost, and the quality of life of patients in the remote postoperative period with an increase in the frequency and duration of incapacity for work, the need for rehabilitation, the financial burden on the patient and his family The aim of our study was to identify neuropsychological indicators of cognitive functions in the short-term and long-term postoperative period in patients with coronary heart disease who underwent off-pump coronary bypass grafting. There were examined 257 patients of 44-78 years old with coronary artery disease, all of them underwent off-pump coronary bypass grafting during period of 2019-2021 years and was hospitalized in the department of Cardiac Surgery at the National scientific center of surgery and transplantation named after O.O. Shalimov, Kyiv, Ukraine. Trail Making Test (TMT) and Mini Mental State Examination (MMSE) were used for cognitive function assessment. This study showed that 47.08% of patients had cognitive dysfunctions after cardiac surgery, which improved in postoperative period after 6 months in 19.01% (n=23) of patients with POCD. Worsening of cognitive performance was observed mainly in older population (65 and older). Geriatric patients had lower cognitive performance and are vulnerable to neurophysiological changes after cardiac surgery, that may be a higher risk of POCD. The results of testing using MMSE and TMT in patients with coronary heart disease who underwent off pump coronary artery bypass grafting revealed that the frequency of POCD with a maximum decrease of cognitive functions was on the 3rd day after surgery with gradual recovery of cognitive functions on 6-8 day. However, in 80.99% of patients with POCD the level of cognitive functions is not recovered in full preoperative score.

References

Bryson GL, Wyand A, Wozny D, Rees L, Taljaard M, Nathan H. A prospective cohort study evaluating associations among delirium, postoperative cognitive dysfunction, and apolipoprotein E genotype following open aortic repair. Can J Anaesth. 2011;58(3):246-55. doi: https://doi.org/10.1007/s12630-010-9446-6

Yuan SM, Lin H. Postoperative Cognitive Dysfunction after Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg. 2019 Jan-Feb;34(1):76-84. doi: https://doi.org/10.21470/1678-9741-2018-0165

Newman MF, Kirchner JL, Phillips-Bute B, Ga-ver V, Grocott H, Jones RH, et al. Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators Longitudinal asses-sment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344(6):395-402. doi: https://doi.org/10.1056/NEJM200102083440601

Rundshagen I. Postoperative cognitive dysfunction. Dtsch Arztebl Int. 2014;111(8):119-25. doi: https://doi.org/10.3238/arztebl.2014.0119

Habib S, Khan Au, Afridi MI, Saeed A, Jan AF, Amjad N. Frequency and predictors of cognitive decline in patients undergoing coronary artery bypass graft surgery. J Coll Physicians Surg Pak. 2014;24(8):543-8.

Laalou FZ, Carre AC, Forestier C, Sellal F, Lan-geron O, Pain L. Pathophysiology of post-operative cogni-tive dysfunction: current hypotheses. J Chir (Paris). 2008;145(4):323-30.

doi: https://doi.org/10.1016/S0021-7697(08)74310-2

Youngblom E, DePalma G, Sands L, et al. The temporal relationship between early postoperative delirium and postoperative cognitive dysfunction in older patients: a prospective cohort study. Can J Anaesth. 2014;61:1084-92. doi: https://doi.org/10.1007/s12630-014-0242-6

Silbert BS, Evered LA, Scott DA. Incidence of postoperative cognitive dysfunction after general or spinal anaesthesia for extracorporeal shock wave lithotripsy. Br J Anaesth. 2014;113:784-91. doi: https://doi.org/10.1093/bja/aeu163

Polunina AG, Golukhova EZ, Guekht AB, Lefterova NP, Bokeria LA. Cognitive dysfunction after on-pump operations: neuropsychological characteristics and optimal core battery of tests. Stroke Res Treat. 2014;2014:302824. doi: https://doi.org/10.1155/2014/302824

Van Harten AE, Scheeren TW, Absalom AR. A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia. Anaesthesia. 2012;67(3):280-93. doi: https://doi.org/10.1111/j.1365-2044.2011.07008.x

Zhang X, Dong H, Li N, Zhang S, Sun J, Zhang S, et al. Activated brain mast cells contribute to postoperative cognitive dysfunction by evoking microglia activation and neuronal apoptosis. J Neuroinflammation. 2016;13(1):127. doi: https://doi.org/10.1186/s12974-016-0592-9

Ge Y, Ma Z, Shi H, Zhao Y, Gu X, Wei H. Incidence and risk factors of postoperative cognitive dysfunc¬tion in patients underwent coronary artery bypass grafting surgery. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2014;39(10):1049-55. doi: https://doi.org/10.11817/j.issn.1672-7347.2014.10.011

Krenk L, Kehlet H, Bæk Hansenetal T. Cognitive dysfunction after fast-track hip and knee replacement. Anesth Analg. 2014;118:1034-40. doi: https://doi.org/10.1213/ANE.0000000000000194

Pan LF, Wang DX, Li J. [Effects of different methods of anesthesia and analgesia on early postoperative cognitive dysfunction after non-cardiac surgery in the elderly]. Journal of Peking University. Health Sciences. 2006;38(5):510-4. Chinese.

Lamy A, Devereaux PJ, Prabhakaran D, et al. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med. 2013;368:1179-88. doi: https://doi.org/10.1056/NEJMoa1301228

Patel N, Minhas JS, Chung EM. Intraoperative embolization and cognitive decline after cardiac surgery: A systematic review. Semin Cardiothorac Vasc Anesth. 2016;20:225-31. doi: https://doi.org/10.1177/1089253215626728

Selnes OA, Gottesman RF, Grega MA, Baumgartner WA, Zeger SL, McKhann GM. Cognitive and neurologic outcomes after coronary-artery bypass surgery. N Engl J Med. 2012;366(3):250-7. doi: https://doi.org/10.1056/NEJMra1100109

Kok WF, Koerts J, Tucha O, et al. Neuronal damage biomarkers in the identification of patients at risk of long-term postoperative cognitive dysfunction after cardiac surgery. Anaesthesia. 2017;72:359-69. doi: https://doi.org/10.1111/anae.13712

Prokopenko SV, Mozheyko EY, Petrova MM, et al. Correc – tion of post-stroke cognitive impairments using computer programs. J Neurological Sciences. Elsevier BV. 2013;325(1-2):148-53. doi: https://doi.org/10.1016/j.jns.2012.12.024

Qiao Y, Feng H, Zhao T, et al. Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation. BMC Anesthesiol. 2015;15:154. doi: https://doi.org/10.1186/s12871-015-0130-9

Helkala EL, Kivipelto M, Hallikainen M, Alhainen K, Heinonen H, Tuomilehto J, et al. Usefulness of repeated presentation of Mini-Mental State Examination as a diagnostic procedure: a population-based study. Acta Neurol Scand. 2002;106(6):341-6. doi: https://doi.org/10.1034/j.1600-0404.2002.01315.x

Saraçli Ö, Akca AS, Atasoy N, Önder Ö, Senor-manci Ö, Kaygisiz I, et al. The relationship between quality of life and cognitive functions, anxiety and depression among hospitalized elderly patients. Clin Psychopharmacol Neurosci. 2015;13(2):194-200. doi: https://doi.org/10.9758/cpn.2015.13.2.194

Jildenstål PK, Hallén JL, Rawal N, Berggren L. Does depth of anesthesia influence postoperative cognitive dysfunction or inflammatory response following major ENT surgery? J Anesth Clin Res. 2012;3(6):220. doi: https://doi.org/10.4172/2155-6148.1000220

Bittner EA, Yue X, Xie F. Brief review: anesdys-function and Alzheimer’s disease. Can J Anaesth. 2010;50(2):216-33.

doi: https://doi.org/10.1007/s12630-010-9418-x

Kok WF, Koerts J, Tucha O, et al. Neuronal damage biomarkers in the identification of patients at risk of long-term postoperative cognitive dysfunction after cardiac surgery. Anaesthesia. 2017;72:359-69. doi: https://doi.org/10.1111/anae.13712

Brown EN, Purdon PL. The aging brain and anesthesia. Curr Opin Anaesthesiol. 2013;26:414-9. doi: https://doi.org/10.1097/ACO.0b013e328362d183

Neupane I, Arora RC, Rudolph JL. Cardiac surgery as a stressor and the response of the vulnerable older adult. Exp Gerontol. 2017;87(Pt B):168-74. doi: https://doi.org/10.1016/j.exger.2016.04.019

Evered LA, Silbert BS, Scott DA, Maruff P, Ames D. Prevalence of dementia 7.5 years after coronary artery bypass graft surgery. Anesthesiology. 2016;125:6271. doi: https://doi.org/10.1097/ALN.0000000000001143

Vega Alonso T, Miralles Espí M, Mangas Rei-na JM, Castrillejo Pérez D, Rivas Pérez AI, Gil Costa M, et al. Prevalence of cognitive impairment in Spain: the Gómez de Caso study in health sentinel networks. Neurologia. 2018 Oct;33(8):491-8. doi: https://doi.org/10.1016/j.nrl.2016.10.002