Risk factors for neurocognitive dysfunction after cardiac surgery in postmenopausal women.
BACKGROUND
Women are at higher risk than men for neurologic complications from cardiac operations. This study identified risk factors for neurocognitive dysfunction after cardiac operations in elderly women.


METHODS
One hundred thirteen postmenopausal women undergoing primary coronary artery bypass grafting, with or without valve operation, underwent psychometric testing and neurologic evaluation the day before operation and 4 to 6 weeks postoperatively. Risk factors assessed for neurologic complications included atherosclerosis of the ascending aorta and apolipoprotein epsilon4 genotype. Postoperative neurocognitive dysfunction was defined as the composite end point of a one standard deviation decrement from baseline on two or more psychometric tests or a new neurologic deficit.


RESULTS
Neurocognitive dysfunction was present in 25% of the women 4 to 6 weeks postoperatively. Women with a neurocognitive deficit tended to be older than those without a deficit (72.1 +/- 8.1 vs 69.4 +/- 8.9 years, p = 0.144) and were more likely to have mild atherosclerosis of the ascending aorta, a history of congestive heart failure, longer duration of cardiopulmonary bypass (CPB) and aortic cross-clamping, lower nadir blood pressure during CPB, higher rates of postoperative atrial fibrillation, and longer postoperative hospitalization. Mild atherosclerosis of the ascending aorta, duration of CPB, duration of aortic cross-clamping (p = 0.051), and length of postsurgical hospitalization were independently associated with postoperative neurocognitive dysfunction.


CONCLUSIONS
Mild atherosclerosis of the ascending aorta, duration of CPB, aortic cross-clamping time, and length of hospitalization, but not apolipoprotein epsilon4 genotype, identified risk for neurocognitive dysfunction after cardiac operation in postmenopausal women.
Hogue
Charles W
CW
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. chogue2@jhmi.edu
Fucetola
Robert
R
Hershey
Tamara
T
Freedland
Kenneth
K
Dávila-Román
Victor G
VG
Goate
Alison M
AM
Thompson
Richard E
RE
D000368:Aged; D001018:Aortic Diseases / Q000453:epidemiology; D001054:Apolipoproteins A / Q000235:genetics; D002315:Cardiopulmonary Bypass; D003072:Cognition Disorders / Q000453:epidemiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000453:epidemiology; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors
D001054:Apolipoproteins A; C022205:apolipoprotein A-IV