Preoperative cognition predicts clinical stroke/TIA and mortality after surgical aortic valve replacement in older adults

ABSTRACT

Stroke and death remain risks of surgical aortic valve replacement (SAVR). Preoperative cognitive screeners repeatedly show that reduced scores predict postoperative outcome, but less is known about comprehensive neuropsychological measures predicting risk. This study had two aims: 1) investigate whether preoperative cognitive measures predicted postoperative clinical stroke/transient ischemic attack (TIA) and mortality in older adults undergoing SAVR, and 2) identify the best predictors within a comprehensive cognitive protocol. A total of 165 participants aged 65 + with moderate-to-severe aortic stenosis completed a comprehensive cognitive test battery preoperatively. Postoperative stroke evaluations were conducted by trained stroke neurologists preoperatively and postoperatively, and mortality outcomes were obtained by report and records. Logistic regressions were conducted to evaluate preoperative cognitive predictors of clinical stroke/TIA within 1 week of surgery and mortality within 1 year of surgery. Multivariate models showed measures of delayed verbal memory recall (OR = 0.86; 95% CI 0.74–0.99) and visuospatial skills (OR = 0.95; 95% CI 0.90–1.01) predicted clinical stroke/TIA within 1 week of surgery, R² = .41, p < .001, ƒ² = .69. Measures of naming ability (OR = 0.88; 95% CI 0.80–0.96), verbal memory recall (OR = 1.23; 95% CI 0.99–1.51), visual memory recall (OR = 0.90; 95% CI 0.80–1.00), medical comorbidities (OR = 1.71; 95% CI 1.22–2.65), and sex (OR = 2.39; 95% CI 0.90–7.04) were significant predictors of death within 1 year of surgery, R² = .68, p < .001, ƒ² = 2.12. Preoperative cognitive measures reflecting temporal and parietal lobe functions predicted postoperative clinical stroke/TIA within 1 week of SAVR and mortality within 1 year of SAVR. As such, cognitive measures may offer objective and timely indicators of preoperative health, specifically vulnerabilities in cerebral hypoperfusion, which may inform intervention and/or intensive postoperative monitoring and follow-up after SAVR.

KEYWORDS:

• Aortic valve stenosis
• aortic valve replacement
• cognition
• stroke
• mortality
• neuropsychology

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, T.G., upon reasonable request.

Additional information

Funding

This work was supported by The National Institutes of Health/National Heart, Lung, and Blood Institute [R01HL084375] to T.F. Floyd. T. Giovannetti’s time also was supported by grants from The National Institute on Aging [R21AG060422, R01AG062503, R21AG066771] to T. Giovannetti, and C.C. Price’s time was supported by a grant from The National Institute on Aging [K07AG066813] to C.C. Price.