Anaesthetic strategies in percutaneous aortic valve implantation: insights from a retrospective cohort study at a leading private hospital in a thriving metropolis of a developing nation

Introduction: Postoperative cognitive dysfunction (POCD) is a decline of one or more neurocognitive abilities that develops after surgery; it is associated with increased morbidity and mortality.Cardiac surgery poses a greater risk of POCD because of the degree of surgical trauma and neuroinflammation precipitated by cardiopulmonary bypass (CPB).1e3 Previous studies have shown an incidence of 30e70%, with older patients at greater risk.This study aimed to reveal the incidence, and patient and surgical associated risks, of early POCD in older patients undergoing cardiac surgery at a tertiary care centre in Thailand.Methods: A single-centre prospective cohort study in older patients who underwent cardiac surgery with CPB use at King Chulalongkorn Memorial Hospital.Participants aged from 65 yr were enrolled and screened using the mini-mental state examination (MMSE).The Montreal Cognitive Assessment test (MOCA) was performed on the day before surgery and on postoperative days 5 to 7. Other surgical and patient data were collected perioperatively.Patient and surgical risks were identified for secondary outcomes.Results: We included 109 patients in the analysis.The incidence of early POCD was 47.6%.Patients who developed POCD were older (mean age 74.02 [6.88]) than those who did not develop POCD (71.64 [5.12], P0.045).Pre-existing cerebrovascular disease (P0.013) and inability to walk 450 m in a 6-min walk test (P0.002)were significantly associated with POCD.Preoperative MOCA score and diabetes mellitus were not significantly associated with POCD.Conclusions: The incidence of early POCD was 47.6%, which was comparable to previous studies.Advanced age, preexisting cerebrovascular disease, and inability to complete 450 m in a 6-min walk test were significantly associated with POCD.These findings might be useful in the prediction, detection, and prevention of POCD in older patients undergoing cardiac surgery.