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Ann Thorac Surg 2006;81:29-33
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Long-Term Neurocognitive Function After Mechanical Aortic Valve Replacement

^a Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
^b Department of Internal Medicine, University of Vienna, Vienna, Austria

Accepted for publication June 10, 2005.

^_* Address correspondence to Dr Zimpfer, Department of Cardiothoracic Surgery, University of Vienna, Wahringer Guertel 18-20, Vienna A-1090, Austria (Email: daniel.zimpfer{at}meduniwien.ac.at).

BACKGROUND: Mechanical aortic valves are a possible source of microemboli potentially causing cerebral injury. Therefore, the long-term impact of mechanical aortic valve replacement on neurocognitive function is uncertain.

METHODS: In this prospective, contemporary study, we followed 32 consecutive patients (aged 51 ± 8 years; range, 38 to 70; EuroSCORE [European System for Cardiac Operative Risk Evaluation] 4.4 ± 1.7) undergoing isolated aortic valve replacement with a mechanical prosthesis. A cohort of age- and sex-matched patients (n = 28, aged 50 ± 7 years) served as nonsurgical controls. After aortic valve replacement, neurocognitive function was serially reevaluated at 7-day (n = 32), 4-month (n = 31), and 3-year (n = 29) follow-up. Neurocognitive function was measured by means of P300 auditory evoked potentials.

RESULTS: Before the operation, P300 peak latencies were comparable between surgical patients (361 ± 32 ms) and nonsurgical controls (365 ± 33 ms, p = 0.783). In patients undergoing aortic valve replacement, P300 peak latencies were prolonged 7 days after surgery (380 ± 32 ms) as compared with before the operation (361 ± 32 ms, p < 0.0001) and as compared with nonsurgical controls (364 ± 34 ms, p = 0.002). At 4-month (369 ± 30 ms, p = 0.752) and 3-year (370 ± 31 ms, p = 0.825) follow-up, P300 peak latencies normalized as compared with before operation and as compared with nonsurgical controls (4-month follow-up 363 ± 31 ms, p = 0.832; 3-year follow-up 366 ± 32 ms, p = 0.432). We found no difference in patients with different valve types.

CONCLUSIONS: Despite previous assumptions based on the potential occurence of microemboli in patients with mechanical valves, mechanical aortic valve replacement has no adverse long-term impact on neurocognitive function. This finding is only valid for patients with a comparable age range undergoing isolated aortic valve replacement.

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				R. W. Emery, A. M. Emery, A. Knutsen, and G. V. Raikar Aortic Valve Replacement with a Mechanical Cardiac Valve Prosthesis Card. Surg. Adult, January 1, 2008; 3(2008): 841 - 856. [Full Text]