Post-Surgical Cognitive Outcomes (S62.001)

OBJECTIVE: To test the hypothesis that aged adults undergoing aortic valve replacement (AVR) are at risk for postoperative cognitive decline and to determine the role of perioperative ischemic events on cognition. BACKGROUND: AVR for calcific aortic stenosis (AS) is increasing. Individuals undergoing AVR for AS are older with concomitant cerebrovascular disease, placing them at increased risk for postoperative cognitive decline. DESIGN/METHODS: 193 participants undergoing open AVR (Mage= 75.9±6.1) and 199 non-surgical controls (Mage=74.3±6.3) with vascular disease completed neuropsychological assessment at baseline, 4-6 weeks post-surgery, and 1-year post-surgery. Neuropsychological variables were reduced using factor analysis on baseline data. Mixed effects models were used to examine differences between surgical and control participants over time, adjusting for baseline age, education, gender, hypertension, and smoking. Secondary analyses, based on repeat neurological exams at post-surgery days 1, 3, and 7, as well as post-surgery MRI of the brain, sub-classified the surgery group according to stroke status [i.e., clinical stroke, silent infarct, no stroke] RESULTS: Surgical participants showed stable cognitive scores over time. Controls showed improving cognitive scores. Factor analysis revealed two baseline neuropsychological factors explaining 87% of the variance: declarative memory (DM) and executive function/processing speed (EF/PS). Surgery and control participants differed significantly on DM over time (p<0.001). Surgical participants scored lower than controls on EF/PS across all time points, including baseline (p = .029). Surgery participants were classified by perioperative stroke: clinical stroke (n = 34), silent infarct (n = 59), or no stroke (n =50); analyses showed the difference in DM was explained by the occurrence of clinical stroke but not silent infarct. Stroke subgroups did not differ on EF/PS. CONCLUSIONS: Patients who undergo AVR demonstrate persistent cognitive decline characterized by diminished learning on tests of memory and language and related to perioperative clinical stroke. These findings underscore the importance of ischemic neurologic complications of surgery and the need for improved stroke prevention and treatment strategies. Study Supported by: R01HL084375 to T.F.F. Disclosure: Dr. Giovannetti has nothing to disclose. Dr. Fanning has nothing to disclose. Dr. Ratcliffe has nothing to disclose. Dr. Price has nothing to disclose. Dr. Messe has received personal compensation for activities with GlaxoSmithKline, Inc. Dr. Messe has received research support from WL Gore, and GlaxoSmithKline, Inc. Dr. Selnes has nothing to disclose. Dr. Acker has nothing to disclose. Dr. Floyd has nothing to disclose. Dr. Szeto has nothing to disclose. Dr. Bavaria has nothing to disclose.