Prevention of Cognitive Frailty in Patients of Older Age Groups after Open-Heart Surgery under Cardiopulmonary Bypass

Document Type : Original Articles

Authors

Belgorod State University, Belgorod, Russia (85 Pobedy Street, Belgorod, 308015)

Abstract

Acute change in mental state is characterized by an impaired level of consciousness, decreased attention, and cognitive changes, and has a variable course throughout its period. Delirium is common in the elderly and hospitalized patients, especially after major surgeries, and increases mortality and morbidity in patients. This study was designed to investigate the relationship between the incidence of delirium after heart surgery and some intrusive factors during surgery. A total of 263 middle-aged, elderly, and chronic patients with functional class III-IV heart failure were classified based on the New York Heart Association classification and valvular heart disease. Cognitive impairment screening was performed using the Mini-Cog test and clock drawing test in addition to standard general clinical examinations on patients. Cognitive impairment was diagnosed in patients with coronary heart disease preparing for planned surgical treatment, regardless of age, while the results of both tests were significantly worse in elderly patients than in their middle-aged counterparts. In the early postoperative period, both among the middle-aged and elderly patients, there was a significant improvement in the results of the clock drawing test. Middle-aged patients also showed improved results on the Mini-Cog test, while the elderly patients showed an increase in cognitive dysfunction. In the third stage of the examination of cognitive function in the two studied groups of patients with valvular pathology at the first checkpoint, no statistically significant differences were found in the Mini-Mental State Examination (MMSE), Mini-Cog, and clock drawing test. The results of the clock drawing test in the main and control groups were recorded at 8.9±0.4 and 5.8±0.3 points, respectively (P<0.05). The MMSE results were estimated at the points of 27.1±0.1 and 24.1±0.2 in the main and control groups, respectively, while the results of the Mini-Cog test were calculated at 2.2±0.2 and 1.2±0.4 words in the main and control group, respectively (P<0.05). The application of the algorithm for the prevention of cognitive frailty in patients of older age groups after open-heart surgery under cardiopulmonary bypass would possibly lead to a decrease in the number of early and late postoperative complications, which shows the necessity of using it for patients of older age groups in multimodal programs to prepare them for surgical interventions.

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  1. Archbold R, Curzen N. Off-pump coronary artery bypass graft surgery: the incidence of postoperative atrial fibrillation. Heart. 2003;89(10):1134-7.
  2. Estruch R, Ros E, Martínez-González MA. Mediterranean diet for primary prevention of cardiovascular disease. N Engl J Med. 2013;369(7):676-7.
  1. Cohn LH, Adams DH. Cardiac surgery in the adult: McGraw-Hill Education; 2017.
  2. Al Ali J, Franck C, Filion KB, Eisenberg MJ. Coronary artery bypass graft surgery versus percutaneous coronary intervention with first-generation drug-eluting stents: a meta-analysis of randomized controlled trials. Circ Cardiovasc Interv. 2014;7(5):497-506.
  3. Sniecinski RM, Chandler WL. Activation of the hemostatic system during cardiopulmonary bypass. Anesthesia & Analgesia. 2011;113(6):1319-33.
  4. Jacobs JP, O’Brien SM, Hill KD, Kumar SR, Austin III EH, Gaynor JW, et al. Refining the Society of thoracic surgeons congenital heart surgery database mortality risk model with enhanced risk adjustment for chromosomal abnormalities, syndromes, and noncardiac congenital anatomic abnormalities. Ann Thorac Surg. 2019;108(2):558-66.
  5. Hsue PY, Deeks SG, Hunt PW. Immunologic basis of cardiovascular disease in HIV-infected adults. J Infect Dis. 2012;205(suppl_3):S375-S82.
  6. Bacchetta MD, Girardi LN, Southard EJ, Mack CA, Ko W, Tortolani AJ, et al. Comparison of open versus bedside percutaneous dilatational tracheostomy in the cardiothoracic surgical patient: outcomes and financial analysis. Ann Thorac Surg. 2005;79(6):1879-85.
  7. Ebert AD, Walzer TA, Huth C, Herrmann M. Early neurobehavioral disorders after cardiac surgery: a comparative analysis of coronary artery bypass graft surgery and valve replacement. J Cardiothorac Vasc Anesth. 2001;15(1):15-9.
  8. Hofsté WJ, Linssen CA, Boezeman EH, Hengeveld JS, Leusink JA, de Boer A. Delirium and cognitive disorders after cardiac operations: relationship to pre-and intraoperative quantitative electroencephalogram. J Clin Monit Comput. 1997;14(1):29-36.
  9. Vukicevic P, Klisic A, Neskovic V, Babic L, Mikic A, Bogavac-Stanojevic N, et al. Oxidative Stress in Patients before and after On-Pump and Off-Pump Coronary Artery Bypass Grafting: Relationship with Syntax Score. Oxid Med Cell Longev. 2021;2021.
  10. Jehan F, Latifi R. Surgery in the Elderly with Mental Health Issues. Surgical Decision Making in Geriatrics: Springer; 2020. p. 419-30.
  11. Görlinger K, Shore-Lesserson L, Dirkmann D, Hanke AA, Rahe-Meyer N, Tanaka KA. Management of hemorrhage in cardiothoracic surgery. J Cardiothorac Vasc Anesth. 2013;27(4):S20-S34.
  12. Catchpole G, Platzer A, Weikert C, Kempkensteffen C, Johannsen M, Krause H, et al. Metabolic profiling reveals key metabolic features of renal cell carcinoma. J Cell Mol Med. 2011;15(1):109-18.
  13. Lomivorotov VV, Efremov SM, Pokushalov EA, Karaskov AM. New-onset atrial fibrillation after cardiac surgery: pathophysiology, prophylaxis, and treatment. J Cardiothorac Vasc Anesth. 2016;30(1):200-16.
  14. Piña IL, Di Palo KE, Ventura HO. Psychopharmacology and cardiovascular disease. J Am Coll Cardiol. 2018;71(20):2346-59.
  15. Jalali A, Simpao AF, Gálvez JA, Licht DJ, Nataraj C. Prediction of periventricular leukomalacia in neonates after cardiac surgery using machine learning algorithms. J Med Syst. 2018;42(10):1-11.
  16. Yousefi R, Imani M, Ardestani SK, Saboury AA, Gheibi N, Ranjbar B. Human calprotectin: effect of calcium and zinc on its secondary and tertiary structures, and role of pH in its thermal stability. Acta Biochim Biophys Sin. 2007;39(10):795-802.
  17. Ryckman C, Vandal K, Rouleau P, Talbot M, Tessier PA. Proinflammatory activities of S100: proteins S100A8, S100A9, and S100A8/A9 induce neutrophil chemotaxis and adhesion. Journal Immunol. 2003;170(6):3233-42.
  18. Kusama Y, Kodani E, Nakagomi A, Otsuka T, Atarashi H, Kishida H, et al. Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management. J Nippon Med Sch. 2011;78(1):4-12.
  19. Salaminia S, Sayehmiri F, Angha P, Sayehmiri K, Motedayen M. Evaluating the effect of magnesium supplementation and cardiac arrhythmias after acute coronary syndrome: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2018;18(1):1-10.
  1. Zisapel N. New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation. Bri J Pharmacol. 2018;175(16):3190-9.
  2. Yilmaz H, Iskesen I. Follow-up with objective and subjective tests of the sleep characteristics of patients after cardiac surgery. Circ J. 2007;71(10):1506-10.
  3. Mourad F, El Ghanam M, Mostafa AE, Sabry W, Bastawy M. Sexual dysfunction before and after coronary artery bypass graft surgery in males. Journal of the Egyptian Society of Cardio-Thoracic Surgery. 2017;25(1):45-51.
  4. Dehestani G, Moeinipour A, Mizani K, Akbari M, Fattahi SP, Moallemi M, et al. Comparison of Sexual Dysfunction Before and After Coronary Artery Bypass Grafting Using the International Index of Erectile Dysfunction Questionnaire. Iran Heart J. 2019;20(3):47-51.
  5. Poole L, Ronaldson A, Kidd T, Leigh E, Jahangiri M, Steptoe A. Pre-surgical depression and anxiety and recovery following coronary artery bypass graft surgery. J Behav Med. 2017;40(2):249-58.
  6. Gallagher R, McKinley S. Stressors and anxiety in patients undergoing coronary artery bypass surgery. Am J Crit Care. 2007;16(3):248-57.
  7. Krannich J-HA, Weyers P, Lueger S, Herzog M, Bohrer T, Elert O. Presence of depression and anxiety before and after coronary artery bypass graft surgery and their relationship to age. BMC psychiatry. 2007;7(1):1-6.