Article Summary
 Is Mitral Valve Repair Better for the Brain than Valve Replacement?
by The DiagnosisHeart.com Physician Team
Posted: March 9, 2003 Summary:
Researchers in Vienna, Austria studied neurocognitive function in patients undergoing mitral valve surgery to determine if mitral valve repair is favored over mitral valve replacement with a prosthesis.
The aim of this prospective study was to measure neurocognitive brain function following mechanical mitral valve replacement and mitral valve repair in forty consecutive patients.
Neurocognitive function was measured by means of P300 auditory evoked potentials (peak latencies, ms) and two standard psychometric tests (Mini Mental State Examination, Trailmaking Test A (TTA)), preoperatively, 7 days and 4 months postoperatively.
There was no difference in neurocognitive brain function in both patients groups before surgery (mechanical valve replacement versus valve repair: P300 potentials 374+/-25 versus 378+/-46 ms; P=0.791 and TTA 57+/-15 versus 54+/-10 s; P=0.552). Following mechanical valve replacement, neurocognitive function continuously worsened (7 day-follow-up: P300 potentials 392+/-28, P=0.001 versus preop and TTA 65+/-17, P=0.0001; 4-month follow-up: P300 potentials 406+/-39, P=0.0004; TTA 69+/-17, P=0.0001).
Neurocognitive brain function was unaffected in patients undergoing valve repair (7-day follow-up: P300 potentials 386+/-40, P=0.890 versus preop and TTA: 53+/-10, P=0.644; 4-month follow-up: P300 potentials 374+/-36, P=0.166 and TTA 54+/-11, P=0.147). At 4-month follow-up, patients with mechanical prostheses performed worse as compared to valve repair (P300 potentials: P=0.024; TTA P=0.014).
This data demonstrates that using P300 auditory evoked potentials and Trailmaking Test A, there is marked neurocognitive damage related to mechanical valve replacement, whereas mitral valve repair does not affect neurocognitive function. This finding supports the beneficial effect of mitral valve repair over mechanical valve replacement in the decision-making tree of borderline cases, which are suitable for both types of procedures.
Surgeons attempt to repair mitral valves whenever possible. Although technically more demanding, the benefits outweigh the incremental risk of additional time spent to repair the valve on the heart-lung machine. This study has substantiated the potential benefits of mitral valve repair versus replacement. In addition to lack of need for prolonged anticoagulation with repair, the study also shows that it may be better than valve replacement on neurocognitive outcome.
Reference:
Neurocognitive Deficit Following Mitral Valve Surgery, European Journal of Cardiothoracic Surgery 23:265-71 Date of Article Publication:
2003, March Web Site: http://www.ctsnet.org |
