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Title: Postoperative cognitive decline following endovascular aortic aneurism surgery : a prospective controlled feasibility cohort study
Author: Benson, Ruth
ISNI:       0000 0004 7972 0667
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2018
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Objectives: Although post-operative cognitive decline (POCD) is a well-recognised neurological phenomenon following cardiothoracic surgery, incidence following aortic aneurysm surgery is unclear, despite equivalent co-morbidity. This pilot study was designed to test the feasibility of our protocol, including incidence and potential risk factors. Methods: Systematic review identified variables with links to POCD after major cardiothoracic surgery. The protocol was designed in collaboration with an anaesthetist, vascular surgeon and clinical psychologist. Patients with thoracic or abdominal aortic aneury sms undergoing endovascular repair were approached for inclusion. Patients on the AAA surveillance programme acted as controls. Cognitive testing was performed pre- and three months after surgery. Operative patients underwent continuous perioperative transcranial Doppler and NIRS monitoring to monitor cerebral embolization and cerebral autoregulation respectively. Serum GFAP was analysed at baseline, in recovery, at 24 and 72 hours. 26 patients underwent postoperative MRI. Cognitive function raw scores and z-scores were analysed against demographic variables and perioperative monitoring. small, analysis failed to link number of peri-operative emboli, frequency of new ischaemic lesions and risk of cognitive decline. GFAP testing suffered several setbacks, and warrants further investigation. Conclusions: This study demonstrates that testing for POCD in an EVAR population is feasible. Importantly, findings link endovascular aortic surgery to significant decline in medium-term cognitive performance compared to controls, warranting further study. Future protocols should be refined based on these findings.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available