Dipl.-Psych. Marius Butz (Gießen / DE; Bad Nauheim / DE), M.Sc.-Psych. Jasmin El-Shazly (Bad Nauheim / DE), Professor Tibo Gerriets (Gießen / DE; Bad Nauheim / DE), M.Sc. Rolf Meyer (Bad Nauheim / DE; Gießen / DE), Dr. Marlene Tschernatsch (Bad Nauheim / DE; Gießen / DE), PD Dr. Tobias Braun (Gießen / DE; Bad Nauheim / DE), Prof. Dr. Patrick Schramm (Bad Nauheim / DE; Gießen / DE), Prof. Dr. Thorsten Döppner (Gießen / DE), PD Dr. med. Stefan Gerner (Gießen / DE), Professor Andreas Böning (Gießen / DE), Professor Yeong-Hoon Choi (Bad Nauheim / DE), Professor Markus Schönburg (Bad Nauheim / DE), PD Dr. Martin Jünemann (Gießen / DE; Bad Nauheim / DE)
Abstract-Text (inkl. Referenzen und Bildunterschriften)
Objectives
Postoperative cognitive deficits (POCD) after cardiosurgical interventions, are well described through objective psychometric tests. However, patients" subjective perception is essential to clinical assessment. This study evaluated patient reported POCD between subjects undergoing coronary artery bypass grafting (CABG) and heart valve replacement (VR).
Methods
This study was a multicenter, prospective questionnaire survey conducted at the cardiac surgery departments at the Kerckhoff Clinic in Bad Nauheim and the University Hospital in Giessen, Germany. We included patients undergoing elective CABG, aortic valve replacement (AVR), mitral valve replacement/reconstruction (MVR), and combined surgery (CABG+VR) with extracorporeal circulation. The Hospital Anxiety and Depression Scale (HADS), Cognitive Failures Questionnaire for self (CFQ-S), and external assessment (CFQ-F) were completed preoperatively as well as at 3 and 12 months postoperatively.
Results
A total of 491 patients were available for analyses (CABG=182, AVR=134, MVR=93, CABG+VR=82). Overall, there was an increase in cognitive failures in daily living from baseline to the 3 and 12-month follow-up assessments (CFQ-S [F=26.496, p<0.001, n2=0.051], CFQ-F [F=31.785, p<0.001, n2=0.061]). Depressive symptoms also increased from the 3-month to the 12-month follow-up (MD=-0.326, d=-0.09, p=0.039). POCD and postoperative depression increase (PODI), defined as a deterioration of 1 standard deviation from pre- to post-assessment, were observed for each surgical procedure (At 3-month follow-up: CFQ-S [CABG=7.1%, AVR=3.7%, MVR=9.7%, CABG+VR=9.8%]; CFQ-F [CABG=9.9%, AVR=9.7%, MVR=9.7%, CABG+VR=15.9%]; PODI [CABG=7.7%, AVR=9.7%, MVR=6.5%, CABG+VR=8.5%]. At 12-months follow-up: CFQ-S [CABG=6.6%, AVR=7.5%, MVR=15.1%, CABG+VR=7.3%]; CFQ-F [CABG=7.1%, AVR=14.9%, MVR=10.8%, CABG+VR=9.8%]; PODI [CABG=10.4%, AVR=11.2%, MVR=6.5%, CABG+VR=4.9%]). No significant between-group effects were observed for the CFQ and HADS.
Conclusions
Postoperative cognitive failures in daily life and depressive symptoms increase following cardiac surgery. The type of surgical procedure (CABG or VR) does not appear to have a differentiating effect. For clinicians it is important to pay attention to patients' self-reported experiences of reduced cognitive function and symptoms of depression following cardiac surgery. This is a clear indication that interventions such as cognitive training or psychotherapy should be considered.