Effects on cognition of conventional and robotically assisted cardiac valve operation.
BACKGROUND
The effect of valve surgical procedures on cognition was investigated in patients undergoing conventional or robotically assisted techniques. The confounding factors of surgical procedure, mood state, preexisting cognitive impairment, and repeated experience with cognitive tests were controlled for.


METHODS
Patients undergoing conventional valve procedures (n = 15), robotically assisted valve procedures (n = 15), and thoracic surgical procedures (n = 15), along with a nonsurgical control group (n = 15) were tested preoperatively, 1 week after operation, and 8 weeks after operation by use of a battery of cognitive tests and a mood state assessment. Surgical group data were normalized against data from the nonsurgical control group before statistical analysis.


RESULTS
Patients undergoing conventional valve procedures performed worse than those undergoing robotically assisted valve procedures on every subtest before operation, and this disadvantage persisted after operation. Age and premorbid intelligence quotient were significantly associated with performance on several cognitive subtests. Anxiety, depression, and stress were not associated with impaired cognitive performance in the surgical groups after operation. A week after operation, patients undergoing conventional valve procedures performed worse on the cognitive tests that had a motor component, which may reflect discomfort caused by the sternotomy. Patients undergoing robotically assisted valve procedures were significantly less impaired on information processing tasks 1 week after operation when compared with those undergoing conventional valve procedures. The majority of patients who were impaired 1 week after operation recovered to preoperation levels within 8 weeks.


CONCLUSIONS
The robotically assisted valve surgical procedure results in more rapid recovery of performance on cognitive tests. However, regardless of the type of surgical intervention, the prospect of a recovery of cognitive performance to preoperative levels is high.
Department of Surgery, Monash University, Melbourne, Australia.
Kathryn M
KM
Bruce
Blood-Brain Interactions Group, School of Psychology and Psychiatry, Monash University, Melbourne, Australia.
Gregory W
GW
Yelland
Department of Surgery, Monash University, Melbourne, Australia; Department of Cardiothoracic Surgery, Monash University, Melbourne, Australia; Cardiothoracic Surgery Unit, Epworth Hospital, Melbourne, Australia.
Aubrey A
AA
Almeida
Department of Surgery, Monash University, Melbourne, Australia; Department of Cardiothoracic Surgery, Monash University, Melbourne, Australia.
Julian A
JA
Smith
School of Health Sciences and Health Innovations Research Institute, RMIT University, Melbourne, Australia. Electronic address: stephen.robinson@rmit.edu.au.
Stephen R
SR
Robinson
D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D009483:Neuropsychological Tests; D012016:Reference Values; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D017678:Sex Distribution; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods
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