Neuropsychological outcomes after pulmonary endarterectomy using moderate hypothermia and periodic circulatory arrest.

BACKGROUND: In this prospective, single-center, observational study, we investigated the association between repeated short periods of circulatory arrest with moderate hypothermia during pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and different neuropsychological dimensions. METHODS: We examined 70 patients with CTEPH, >18 to 80 years of age, who had been treated with PEA. Neuropsychological testing was performed. RESULTS: Learning ability and delayed memory remained well within the normal range for patients' age. We found a statistically significant post-surgical improvement in motor speed, which was accompanied by a better quality of life and reduced symptoms of depression and anxiety. CONCLUSION: PEA with repeated short periods of circulatory arrest in CTEPH did not result in any neuropsychological complications and may even lead to post-surgical psychological improvements.

Preoperative education on postoperative delirium, anxiety, and knowledge in pulmonary thromboendarterectomy patients.

BACKGROUND: Delirium is the most common postoperative psychiatric condition in intensive care settings and can lead to increased complications and costs. OBJECTIVES: To evaluate the impact of multifaceted preoperative patient education on postoperative delirium, anxiety, and knowledge and to explore predictors of postoperative delirium, days of mechanical ventilation, and days in the intensive care unit (ICU) in patients undergoing pulmonary thromboendarterectomy. METHOD: A prospective, randomized controlled trial was conducted on consented patients from October 2011 to April 2013. Patients were randomized in a 1 to 1 ratio to receive either an individualized 45-minute multifaceted preoperative education (experimental group, n = 63) or standard education (control group, n = 66). Participants completed the State-Trait Anxiety Inventory and Knowledge Test before and after the education. Data on incidence of delirium, days of mechanical ventilation, ICU days, and cardiopulmonary parameters were collected. RESULTS: The experimental group had significantly more knowledge about postoperative care (P< .001) and fewer days of mechanical ventilation (P = .04) than the control group. The 2 groups did not differ significantly in anxiety, incidence of delirium, or ICU days. In exploratory multivariate analyses, hearing impairment was a positive predictor for days of delirium (P = .009), days of mechanical ventilation (P< .001), and ICU days (P= .049), whereas the posttest knowledge was a negative predictor for days of mechanical ventilation (P = .02). CONCLUSION: The patient education appeared to be effective in improving knowledge and reducing days of mechanical ventilation. Hearing impairment was an unexpected predictor of adverse outcomes for patients but may be amenable to nursing intervention.

Replacement of the heavily calcified ascending aorta in aortic valve replacement.

A totally calcified ascending aorta prevents aortic crossclamping and aortotomy during aortic valve replacement, and replacement of the ascending aorta is a valid option in these cases. We describe a simple technique for calcified ascending aorta replacement using the Cavitron Ultrasonic Surgical Aspirator. This can be used in aortic endarterectomy for removal of the calcified plaque in the anastomotic part.

Screened individuals' preferences in the delivery of abdominal aortic aneurysm repair.

BACKGROUND: This study aimed to determine preferences for service attributes in a population screened for abdominal aortic aneurysm. METHODS: A questionnaire was designed to encompass various aspects of service provision. Questions were calibrated against the time an individual was willing to travel to access specific attributes. Subjects attending an aneurysm screening programme were asked to complete a questionnaire before their screening ultrasound scan. Statistical analysis was through pairwise analysis of the median travel times with the signed rank test. The Wilcoxon rank sum, analysed by the Kruskal-Wallis test, was used to compare preference ratings. RESULTS: A total of 262 individuals were asked to complete the questionnaire; the response rate was 98.5 per cent. Approximately 92 per cent of individuals stated a willingness to travel for at least 1 h beyond their nearest hospital in order to access services with a 5 per cent lower perioperative mortality rate, a 2 per cent lower amputation or stroke rate, a high annual caseload of aneurysm repairs, and routine availability of endovascular repair. CONCLUSION: Patients attending aneurysm screening were willing to travel beyond their nearest hospital to access a service with better outcomes, higher surgical volumes and endovascular surgery.

Neuropsychological improvement versus practice effect following unilateral carotid endarterectomy in patients without stroke.

Patients who were admitted to hospital for a recent transient ischemic attack were entered into one of three groups based on medical and surgical characteristics; those with an abnormal neurological examination or a focal abnormality on CT Scan were omitted from the study. The two surgical groups (12 patients each) underwent either a left or right endarterectomy for a symptomatic atheroma of the ipsilateral carotid artery. The control group consisted of 12 patients who either demonstrated minor or nonexistent carotid abnormalities or a TIA distribution that was contralateral to what would otherwise have been a surgically treatable lesion. Patients were tested before surgery and again 6-8 weeks later with the WAIS, WMS, and other neuropsychological measures. Significant improvement on some measures at follow-up was strictly equivalent across all groups and was attributed to practice effects.

The effect of unilateral carotid endarterectomy on neuropsychological test performance in 53 patients.

Six psychomotor tests (Ravens matrices, finger tapping, spatial orientation, arithmetic, vocabulary, and short-term memory) were administered preoperatively, at 3-7 days and 3 months postoperatively to 53 patients undergoing unilateral carotid endarterectomy between 1978 and 1982. Standard operative technique included general anesthesia and Javid shunt. None of the patients experienced postoperative neurological deficit or significant complications. Individual and cumulative test scores were correlated with prior CVA, neurological examination, cerebral angiography, pre and postoperative computerized cerebral tomograms and intraoperative carotid flow measurements. Psychometric scores did not change postoperatively in 18 patients with prior CVA's. Forty-five patients operated upon for high grade stenosis (75% reduction in cross sectional diameter) had a significant increase in early post-endarterectomy test scores which returned to preoperative levels by three months postoperatively. Increase in intra-operative carotid artery blood flow correlated with improved test performance. We conclude that carotid endarterectomy of flow restrictive stenosis initially augments psychometric test performance but the improvement is not sustained at the third postoperative month.

Mental status outcomes following carotid endarterectomy: a six-month analysis.

Fifty-one male and two female patients were divided into the following three groups: (a) patients with symptomatic carotid artery disease who received carotid endarterectomies, (b) patients with symptomatic carotid artery disease who either declined or were not candidates for carotid endarterectomies, and (c) patients who received a surgical procedure unrelated to cerebral functioning. The three groups were not significantly different in terms of age or educational level. The subjects were examined using the WAIS, Wechsler Memory Scale, Halstead-Reitan Neuropsychological Battery, Sickness Impact Profile, and Profile of Mood States. The assessments were conducted presurgery and repeated at a 6 month follow-up. The results of two-way analyses of variance revealed a significant trials effect for a majority of the variables, including the average impairment rating and the full scale WAIS IQ. However, significant group x trials interactions were not found for either the neuropsychological measures or the quality of life indices. The results did not support the conclusion of improved mental status or increased psychosocial well-being in patients who received carotid endarterectomies.

[Reversible cerebral ischemia: psychological reactions to the disease]. / L'ischemia cerebrale reversibile: reazioni psicologiche alla malattia.

Two different psychological tests were applied to 40 patients affected by reversible cerebral ischemic attacks in order to evaluate the presence of depression or neurotic symptoms. 40 normal volunteers were used as a control group. While no statistical differences emerged in the mean values of the control tests, significant psychological impairments were observed in the group of patients. Such psychological disturbances were marked in the series with minor neurological deficits. Similar reactions were noted in subjects still employed and in patients submitted to carotid surgery. The authors emphasize the importance of psychological reactions following organic disease for a better therapy in reversible cerebrovascular disorders.