Cognitive Outcomes After Heart Valve Surgery: A Systematic Review and Meta-Analysis

Abstract

Objectives: To summarize evidence on cognitive outcomes after heart valve surgery; secondary aim, to examine whether aortic and mitral valve surgery are associated with different cognitive outcomes. Design: Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review and meta-analysis. Setting: Cardiac surgery. Participants: Individuals undergoing heart valve surgery. Measurements: We searched MEDLINE, EMBASE, and PsycINFO for peer-reviewed reports of individuals undergoing heart valve surgery who underwent pre- and postoperative cognitive assessment. Our initial search returned 1,475 articles, of which 12 were included. Postoperative cognitive results were divided into those from 1 week to 1 month (early outcomes, npooled = 450) and from 2 to 6 months (intermediate outcomes; npooled = 722). No studies with longer-term outcomes were identified. Results: Subjects had moderate early cognitive decline from baseline (Becker mean gain effect size (ES)=−0.39 ± 0.27) that improved slightly by 2 to 6 months (ES=–0.25 ± 0.38). Individuals undergoing aortic valve surgery—who were older on average than those undergoing mitral valve surgery (68 vs 57)—had greater early cognitive decline than those undergoing mitral valve surgery (ES=–0.68 vs −0.12), but both cohorts had similar decline 2 to 6 months postoperatively (ES=–0.27 vs −0.20). Conclusions: Heart valve surgery is associated with cognitive decline over the 6 months after surgery, but outcomes beyond 6 months are unclear. These findings highlight the cognitive vulnerability of this population, especially older adults with aortic stenosis. © 2018 American Geriatrics Society and Wiley Periodicals, Inc. J Am Geriatr Soc 66:2327–2334, 2018.