Predictors of the development of cognitive impairment in patients undergoing pulmonary thromboendarterectomy

Aim: To study the clinical and functional features, as well as intra- and postoperative indicators of patients with chronic thromboembolic pulmonary hypertension (CTEPH) with the development of negative dynamics of cognitive status in the early postoperative period and to identify pathophysiological factors associated with this disorder.
Material and Methods. The study included patients with CTEPH scheduled for pulmonary endarterectomy (PEA). The 1st group (38 people) consisted of patients with the development of negative dynamics of cognitive functions according to the MMSE scale in the early postoperative period, the 2nd group (91 people) – without negative dynamics of cognitive functions. Preoperative clinical, anamnestic data, intraoperative parameters, early postoperative complications and their relationship with the negative postoperative dynamics of cognitive status were analyzed.
Results. The average age of patients in the general group was 54.1 (44.3–68.1) years. The 1st group was characterized by older age (p = 0.03), a prevalence of patients with diabetes mellitus (p = 0.02), arterial hypertension (p = 0.04), atherosclerosis of the brachiocephalic arteries ≤ 50% (p = 0.04) and higher level of Charlesson comorbidity index (p = 0.002) in comparison with the 2nd group. Intraoperative factors for the development of postoperative cognitive impairment were a longer circulatory arrest (CA) during PEA and a more pronounced decrease in cerebral oxygenation during CA. The 1st group of patients were characterized by a large number of complications, including pulmonary heart failure (p = 0.02), acute renal failure (p < 0.001) and atrial fibrillation (p < 0.001) in comparison with the 2nd group. The development of negative postoperative dynamics of cognitive status in CTEPH patients was associated with baseline reduced cognitive function – OR 2.3 (1.4–9.2 95% CI) (p = 0.01) and with the presence of three or more CA during PEA – OR 3.2 (1.1–12.7 95% CI) (p = 0.01).
Conclusion. Independent factors for the development of negative postoperative dynamics of cognitive status in patients with CTEPH were baseline impairment of cognitive function (< 20 points according to the MMSE scale), three or more CA during PEA, and the development of new-onset atrial fibrillation in the early postoperative period.

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