학술논문
Does cognition improve following LVAD implantation?
Document Type
Academic Journal
Author
Pavol MA; Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA. mp2740@cumc.columbia.edu.; Willey JZ; Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA.; Wei Y; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.; Yuzefpolskaya M; Cardiology Division, Department of Medicine,, Columbia University College of Physicians and Surgeons, New York, NY, USA.; Marshall RS; Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA.; Marascalco PJ; Terumo Heart, Inc, Ann Arbor, MI, USA.; Harwood J; Terumo Heart, Inc, Ann Arbor, MI, USA.; Lazar RM; Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA.
Source
Publisher: Springer Japan Country of Publication: Japan NLM ID: 101303952 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1863-6713 (Electronic) Linking ISSN: 18636705 NLM ISO Abbreviation: Gen Thorac Cardiovasc Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Studies of cognition after LVAD surgery have produced mixed results. To explore whether cognition would improve, decline, or remain stable after LVAD surgery, we examined cognition before and 1- and 3-months after LVAD surgery. Patients with post-surgical stroke were excluded.
Methods: 28 subjects (mean age = 54.31 ± 12 years) comprised an observational case series from the DuraHeart LVAS device® trial. Cognitive testing was performed at baseline, 1-month, and 3-month post-surgery, and included tests of attention, memory, language, visualmotor speed (TMT) and visualconstruction.
Results: No difference in cognition was found between baseline and 1-month exams (means z score improvement = 0.06, p = 0.43) but cognition improved significantly between baseline and 3-month exams (mean z score improvement = 0.34, p < 0.00001). Examination of individual test scores found, after correction for multiple comparisons, only the TMT variable was significantly different at the 3-month exam.
Conclusions: We found significantly improved cognition 3 months after LVAD surgery in a subset of patients without post-surgical stroke. The reasons for the lack of cognitive improvement at the 1-month post-surgical assessment may include ongoing medical and physiological disruptions in the immediate post-operative period. Further research into the sources of delayed improvement is warranted. Cognitive assessments performed immediately after surgery should be interpreted with caution because the results may not reflect longer term cognitive outcomes. LVAD patients may require additional support to successfully manage their health in the weeks immediately following surgery but assistance needs may decrease over time.
Methods: 28 subjects (mean age = 54.31 ± 12 years) comprised an observational case series from the DuraHeart LVAS device® trial. Cognitive testing was performed at baseline, 1-month, and 3-month post-surgery, and included tests of attention, memory, language, visualmotor speed (TMT) and visualconstruction.
Results: No difference in cognition was found between baseline and 1-month exams (means z score improvement = 0.06, p = 0.43) but cognition improved significantly between baseline and 3-month exams (mean z score improvement = 0.34, p < 0.00001). Examination of individual test scores found, after correction for multiple comparisons, only the TMT variable was significantly different at the 3-month exam.
Conclusions: We found significantly improved cognition 3 months after LVAD surgery in a subset of patients without post-surgical stroke. The reasons for the lack of cognitive improvement at the 1-month post-surgical assessment may include ongoing medical and physiological disruptions in the immediate post-operative period. Further research into the sources of delayed improvement is warranted. Cognitive assessments performed immediately after surgery should be interpreted with caution because the results may not reflect longer term cognitive outcomes. LVAD patients may require additional support to successfully manage their health in the weeks immediately following surgery but assistance needs may decrease over time.