, Volume 16, Issue 5, pp 149-156
Date: 11 Dec 2012

Postoperatieve cognitieve disfunctie en neuroinflammatie na hartchirurgie

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De eerste publicaties over cognitieve problemen die zich voordeden na hartoperaties verschenen binnen enkele jaren na de introductie van openhartchirurgie (Boshes et al., 1957). Destijds richtte het onderzoek zich met name op de psychologische aspecten zoals angst, depressie en stress gerelateerd aan het toen nog experimentele karakter van de operatie en de kleine kans om deze goed door te komen, of zelfs maar te overleven. Met de toegenomen ervaring en de verbeterde anesthesiologische en chirurgische technieken is de sterfte rondom de operatie en tijdens postoperatieve ziekenhuisopname drastisch afgenomen, tot ongeveer een tot drie procent (Hannan et al., 2005 ; Shroyer et al., 2003 ). Maar ondanks de afgenomen incidentie van andere complicaties, is de incidentie van postoperatieve cognitieve problemen onveranderd gebleven. (Rabiner et al., 1975 ; Newman et al., 2001b; Knipp et al., 2008 ).

Postoperative cognitive dysfunction is receiving increasing attention, particularly as it mainly affects the (growing) elderly population. Until recently, cognitive deficits after cardiac surgery were thought to be caused by physiological disturbances associated with the cardiopulmonary bypass technique. Although the technique of ‘off-pump’ coronary revascularisation may potentially be associated with improved outcome, long-term follow-up studies have failed to demonstrate a significant reduction in the incidence of postoperative cognitive dysfunction. The focus of research is thus shifting from cardiopulmonary bypass to other factors common to both techniques, such as surgery, anesthesia, and patient-related predisposing factors. Priming of the immune system by ageing and atherosclerosis may result in an exaggerated systemic and cerebral inflammatory response to cardiac surgery and anesthesia, causing neuronal loss or dysfunction resulting in cognitive dysfunction. We briefly discuss the evidence for cardiopulmonary bypass-related neuronal injuries in adult cardiac surgery patients, and review the evidence that immune priming is a key factor in the pathogenesis of cognitive dysfunction after cardiac surgery.

AIOS anesthesiologie,
hoogleraar anesthesiologie, hoofd Sectie Cardiothoracale Anesthesiologie,
hoogleraar anesthesiologie,