Cognitive Outcomes After Heart Valve Surgery: A Systematic Review and Meta-Analysis

Objectives To summarize evidence on cognitive outcomes after heart valve surgery; secondary aim, to examine whether aortic and mitral valve surgery are associated with different cognitive outcomes. Design Preferred Reporting Items for Systematic Reviews and Meta‐Analyses systematic review and meta‐analysis. Setting Cardiac surgery. Participants Individuals undergoing heart valve surgery. Measurements We searched MEDLINE, EMBASE, and PsycINFO for peer‐reviewed reports of individuals undergoing heart valve surgery who underwent pre‐ and postoperative cognitive assessment. Our initial search returned 1,475 articles, of which 12 were included. Postoperative cognitive results were divided into those from 1 week to 1 month (early outcomes, npooled = 450) and from 2 to 6 months (intermediate outcomes; npooled = 722). No studies with longer‐term outcomes were identified. Results Subjects had moderate early cognitive decline from baseline (Becker mean gain effect size (ES)=−0.39 ± 0.27) that improved slightly by 2 to 6 months (ES=–0.25 ± 0.38). Individuals undergoing aortic valve surgery—who were older on average than those undergoing mitral valve surgery (68 vs 57)—had greater early cognitive decline than those undergoing mitral valve surgery (ES=–0.68 vs −0.12), but both cohorts had similar decline 2 to 6 months postoperatively (ES=–0.27 vs −0.20). Conclusions Heart valve surgery is associated with cognitive decline over the 6 months after surgery, but outcomes beyond 6 months are unclear. These findings highlight the cognitive vulnerability of this population, especially older adults with aortic stenosis. © 2018 American Geriatrics Society and Wiley Periodicals, Inc. J Am Geriatr Soc 66:2327–2334, 2018