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Original Articles: Adult Cardiac

Risk Factors for Neurocognitive Dysfunction After Cardiac Surgery in Postmenopausal Women

^a Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
^f Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
^b Department of Neurology, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
^c Department of Psychiatry and Radiology, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
^d Department of Psychiatry, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
^e Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri

Accepted for publication April 16, 2008.

^_* Address correspondence to Dr Hogue, Jr, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, 600 N. Wolfe St, Tower 711, Baltimore, MD 21287 (Email: chogue2{at}jhmi.edu).

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 4 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 4 genotype, identified risk for neurocognitive dysfunction after cardiac operation in postmenopausal women.