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Does cognition improve following LVAD implantation?

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Abstract

Background

Studies of cognition after LVAD surgery have produced mixed results. To explore whether cognition would improve, decline, or remain stable after LVAD surgery, we examined cognition before and 1- and 3-months after LVAD surgery. Patients with post-surgical stroke were excluded.

Methods

28 subjects (mean age = 54.31 ± 12 years) comprised an observational case series from the DuraHeart LVAS device® trial. Cognitive testing was performed at baseline, 1-month, and 3-month post-surgery, and included tests of attention, memory, language, visualmotor speed (TMT) and visualconstruction.

Results

No difference in cognition was found between baseline and 1-month exams (means z score improvement = 0.06, p = 0.43) but cognition improved significantly between baseline and 3-month exams (mean z score improvement = 0.34, p < 0.00001). Examination of individual test scores found, after correction for multiple comparisons, only the TMT variable was significantly different at the 3-month exam.

Conclusions

We found significantly improved cognition 3 months after LVAD surgery in a subset of patients without post-surgical stroke. The reasons for the lack of cognitive improvement at the 1-month post-surgical assessment may include ongoing medical and physiological disruptions in the immediate post-operative period. Further research into the sources of delayed improvement is warranted. Cognitive assessments performed immediately after surgery should be interpreted with caution because the results may not reflect longer term cognitive outcomes. LVAD patients may require additional support to successfully manage their health in the weeks immediately following surgery but assistance needs may decrease over time.

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Acknowledgements

Partial support for this work was provided by Terumo Medical Inc. The authors would like to thank Databean, LLC for assistance in data collection. The authors would like to thank Jimmy K. Duong, MPH (Mailman School of Public Health, Columbia University) for assistance with statistical analyses.

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Authors and Affiliations

  1. Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA

    Marykay A. Pavol, Joshua Z. Willey, Randolph S. Marshall & Ronald M. Lazar

  2. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA

    Ying Wei

  3. Cardiology Division, Department of Medicine,, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Melana Yuzefpolskaya

  4. Terumo Heart, Inc, Ann Arbor, MI, USA

    Philip J. Marascalco & Jason Harwood

Authors
  1. Marykay A. Pavol
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  2. Joshua Z. Willey
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  3. Ying Wei
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  4. Melana Yuzefpolskaya
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Corresponding author

Correspondence to Marykay A. Pavol.

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Conflict of interest and funding sources

Author M. Pavol received support from Terumo Medical, Inc. for selection of the cognitive tests and collection and scoring of cognitive data for the Duraheart LVAS® study. No payment was received for manuscript preparation. Authors P. Marascalco and J. Harwood are employees of Terumo Heart, Inc. and assisted with collection, interpretation, and design of tables for adverse outcomes.

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Pavol, M.A., Willey, J.Z., Wei, Y. et al. Does cognition improve following LVAD implantation?. Gen Thorac Cardiovasc Surg 66, 456–463 (2018). https://doi.org/10.1007/s11748-018-0947-5

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  • DOI: https://doi.org/10.1007/s11748-018-0947-5

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