Does open heart surgery affect cognitive abilities?

October 12, 2018

Most people who need open heart surgery to repair damaged heart valves are aged 65 or older. The American Heart Association (AHA) estimates that nearly 8 million people have had heart surgeries. However, we don't fully understand the effects of heart surgery on an older adult's cognition (the ability to remember, think, and make decisions).

In 2014, an estimated 156,000 heart valve surgeries were performed in the US. The most common condition for valve surgery was aortic stenosis. The aorta is the heart valve that controls blood flow from your heart to the rest of your body. Aortic stenosis occurs when the aortic valve doesn't allow blood to flow out of the heart properly. Adults 65 and older represent most of the people who need aortic valve surgery, and the number of older adults with aortic stenosis is expected to double by 2050.

Understanding how heart valve surgery may affect your cognition is important for older adults. To learn more, researchers reviewed studies to see how patients' cognition changed before and after heart valve surgery. They also looked at whether surgeries on two types of heart valves, the mitral or the aortic, were associated with better or worse outcomes. Their study was published in the Journal of the American Geriatrics Society.

To learn more, researchers reviewed 12 studies that included hundreds of people who had heart valve surgery. In each of the studies, participants had been tested before and after surgery to determine their ability to remember, think, and make decisions.

The researchers found that within the first month after valve surgery, people in the studies experienced some cognitive decline compared to before the surgery. Up to six months after surgery, patients' cognitive health had largely returned to normal. One-third of the studies included in this review even found small improvements in cognition half a year after surgery.

The researchers also learned that aortic valve surgery was associated with more early cognitive problems than mitral valve surgery.

People who had mitral valve surgery experienced a mild decline from their one-month check-up to their check-ups from two to six months after surgery. But people who had aortic valve surgery experienced poorer cognitive function the month after surgery, although they tended to improve after that.

Importantly, the researchers also learned that aortic valve patients were, on average, a decade older than mitral valve patients (68 years vs. 57). Because the people who had aortic valve surgeries were older, their increased age might have affected their cognitive decline.

The researchers concluded that heart valve surgery patients are at risk of cognitive problems up to six months after surgery. People having aortic valve surgery--the majority of whom are older adults--are at greater risk of early cognitive decline within the first month after surgery than people having mitral valve surgery. However, cognitive health in both groups appears largely to return to what it was before surgery within the six months after surgery.
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This summary is from "Cognitive outcomes after heart valve surgery." It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Mark A. Oldham, MD; Jacqueline Vachon, MSc; David Yuh, MD; and Hochang B. Lee, MD.

About the Health in Aging Foundation

This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.HealthinAgingFoundation.org.

About the Journal of the American Geriatrics Society

Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.

About the American Geriatrics Society

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has--for 75 years--worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.

American Geriatrics Society

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