Name:
Anne-Mette C. Sauër
Department anesthesiology
Section Cerbrovascular disorders
Function:
PhD-student, MD
E-mail:
a.c.sauer@umcutrecht.nl Tel: +31 88 75 59676
Pager: 4372
Supervisor:
D. van Dijk, MD, PhD
Title research:
Cerebral outcomes after cardiac surgery
Summary research:
Cardiac surgery is associated with cerebral injury, usually manifested as stroke, cognitive decline, or delirium. The etiology is probably multifactorial, and may include cerebral macro emboli due to manipulation of the ascending aorta, micro emboli from the cardiopulmonary bypass (CPB) and cardiotomy suction, and the inflammatory response to CPB, major surgery, and blood transfusion.
Recent studies have shown that avoiding CPB improves cognitive outcomes in the first months after cardiac surgery. Long –term cognitive decline, however, is not influenced by the use of CPB. It is conceivable that long-term cognitive decline is not caused by the operation, but reflects generalized vascular disease leading to earlier cerebral ageing. We will therefore compare long-term cognitive outcomes in 280 patients who were randomized to balloon angioplasty or coronary bypass surgery 7 years ago.
We have also found that the presence of coronary collaterals is associated with improved cognitive outcomes. We speculate that coronary collaterals may reflect an overall better vascular condition and we will therefore use MRI to study a possible relationship between coronary collaterals and completeness of the circle of Willis, or other cerebral collateral arteries.
Postoperative fever and postoperative cerebral oedema appear to predict lower cognitive performance. Suppression of the postoperative inflammatory response may therefore improve cognitive outcome. The multi-centre DECS trial currently randomizes 4500 cardiac surgical patients to intraoperative administration of dexamethasone or placebo. We will assess cognitive outcomes in a sub-sample of these patients, recruited at the UMC Utrecht.
Because neuropsychological assessments are laborious and expensive, we will develop an internet-based tool to measure cognitive performance. This tool will be validated in participants of the DECS trial.
Delirium is a frequently occurring complication after cardiac surgery, usually occurring during the postoperative intensive care admission. Delirium may reflect intraoperative cerebral emboli or cerebral oedema, and may predict post-discharge cognitive decline. In a large retrospective study, we will try to identify predictors of delirium. We will also establish a possible association between postoperative delirium and postoperative cognitive decline. Finally, we will study the effect of dexamethasone on the incidence of delirium in the 4500 participants of the DECS trial.
Publications:
Dieleman J, Sauer AM, Klijn C, Nathoe H, Moons K, Kalkman C, Kappelle J, Van DD. Presence of coronary collaterals is associated with a decreased incidence of cognitive decline after coronary artery bypass surgery. Eur J Cardiothorac Surg 2009 January;35(1):48-53.