Untersuchungen zu perioperativen Kognitionsveränderungen und deren Beeinflußbarkeit im Rahmen herzchirurgischer Eingriffe
Cognitive deficits can be detected even months after cardiac surgery particularly if the heart lung machine (HLM) was used. Since the number of older patients undergoing cardiac operations is increasing, frequency of cognitive deficits increases as well. This leads to longer hospital stay, lower rehabilitation potential and last but not least a higher mortality. Genesis of postoperative cognitive deficits (POCD) is multifactorial. Operative techniques and materials contribute to micro- and
... to micro- and macroembolisation which needs to be refined. Aim: Evaluation of the impact of different operative techniques, materials and drugs on perioperative cognitive development of cardiac surgical patients. Thereby showing possibilities to reduce POCD. Method: Patients undergoing cardiac surgery were evaluated before and early after the operation using a neuropsychological test battery. Cognitive outcome of transcatheter aortic valve implantation (TAVI) was compared to standard surgical aortic valve replacement. Moreover, cognitive impact of HLM pump type, dual antiplatelet therapy (DAPT) and Piracetam in patients undergoing coronary artery bypass grafting (CABG) and those with open left heart surgery (OLHS) was studied. Results: TAVI as well as application of Piracetam in OLHS did not show a cerebroprotective effect. However, different strategies in coronary bypass surgery proofed to better preserve patients cognitive abilities. Preoperative intake of DAPT and a single dose of Piracetam at the beginning of the operation led to a reduction of POCD in CABG patients. There was less cognitive decline in patients operated with roller pumps as part of the HLM instead of centrifugal pumps. Conclusion: The aim was mainly achieved for bypass surgery since three effective measures to reduce POCD in CABG patients were found.