Single gene may predict mental decline after heart surgery

Preliminary study suggests blood test could help doctors assess patient's risk.

16 oct 2013—A certain gene appears to increase risk for mental decline after heart surgery, a new study suggests.

Between 30 percent and 50 percent of heart surgery patients have a decrease in mental function after heart surgery, but it hasn't been known if this is a side effect of the surgery and anesthesia, or a progression of existing neurologic disease, the researchers said.

Their study included 233 elderly, white patients whose mental function was assessed before heart surgery and five years after.

Those with the APOE4 gene were more likely than those without the gene to experience long-term memory loss, attention problems and difficulty understanding spoken or written words five years after the surgery, according to the study scheduled for presentation Sunday at the annual meeting of the American Society of Anesthesiologists in San Francisco.

"Our findings suggest that the long-term cognitive decline previously seen after surgery is related more to the patient's genetic makeup than to the surgery itself," Dr. Karsten Bartels, who helped conduct this study while a fellow in cardiothoracic anesthesiology and critical care medicine at Duke University Medical Center, said in a society news release.

"Knowing which patients have the APOE4 genotype can help doctors assess the risk for cognitive problems following surgery, ultimately allowing patients to make better-informed decisions and permitting doctors to direct strategies to protect the brain after surgery," he explained.

People are born with the APOE4 (apolipoprotein E4) gene, which can be detected in a blood test. Apolipoproteins play an important role in cholesterol metabolism and inflammation.

APOE4 has been shown to increase the risk of developing Alzheimer's disease.

Data and conclusions presented at medical meetings are typically considered preliminary until published in a peer-reviewed medical journal.

More information: The U.S. National Heart, Lung, and Blood Institute has more about heart surgery.

Octogenarians have more heart surgery, live longer

NEW YORK , 05 aug 2010-- Heart surgery and the use of other invasive treatments have risen sharply in elderly people who've suffered a heart attack, Canadian researchers said Tuesday.

In addition, the number of deaths within one year of those heart attacks dropped by almost 10 percent between 1996 and 2006, data from Quebec hospital patients aged 80 and older show.

"Over the last decade we are doing procedures in patients once believed to be too old for these procedures," said chest surgeon Dr. Mark R. Katlic, of Geisinger Wyoming Valley Medical Center in Wilkes-Barre, Pennsylvania, who was not involved in the new study.

"It's my belief that this is a positive development," he said, cautioning that the study didn't prove the new treatment had reduced the number of deaths.

An earlier study found that U.S. heart patients of all ages are more likely to undergo procedures to clear blocked coronary arteries than are Canadians.

The current study, published in the Canadian Medical Association Journal, was carried out by Dr. Louise Pilote and colleagues of McGill University in Montreal.

Over a 10-year period, the researchers found that nearly 30,000 octogenarians in Quebec had suffered a heart attack.

In 1996, most of the patients received standard medications such as beta-blockers and cholesterol-lowering drugs, and only a few percent underwent invasive procedures.

Ten years later, however, that number had ballooned: A quarter of all patients were undergoing angioplasty, a procedure in which the doctor cleans out the blocked arteries that caused the heart attack.

Overall, almost half the patients died within a year of their heart attacks in 1996, while fewer than four in ten died in 2006.

The drop in mortality only occurred in patients who had undergone invasive procedures, suggesting those treatments might help patients survive longer. But it's possible that other changes in how doctors managed the patients could also have been involved.

Heart attacks kill more than 400,000 people in the U.S. every year according to the American Heart Association, and heart disease remains the leading cause of death.

Dr. Katlic, who wrote an editorial about the new study, said it was important to consider the cost of the procedures, which may amount to tens of thousands of dollars.

Medications are much less expensive, he told Reuters Health, but it's unclear if they are equally effective at preventing another heart attack.

"We should also study whether the quality of life is better after these procedures," he said.

SOURCE: link.reuters.com/ceh23n Canadian Medical Association Journal, online August 3, 2010.

Octogenarians can be good candidates for heart surgery

Open-heart surgery should remain a viable treatment option for people in their 80s, according to experts at the MUHC

Montreal, 29 oct 2008 - Patients 80 years and older who are in overall good health are perfectly able to withstand open-heart surgery, according to the latest study of Dr. Kevin Lachapelle of the McGill University Health Centre (MUHC). His findings were presented this morning in Toronto during the 2008 Canadian Cardiovascular Congress.
"Age should not be a reason for doctors to rule out the possibility of heart surgery for their octogenarian patients," explained Dr. Lachapelle. "If patients with heart problems are otherwise in good health, this surgery can significantly improve their quality of life."
This study conclusion is based on the follow-up of 185 patients who underwent open-heart surgery at the MUHC for a cardiac valve replacement. Five years after the operation, 60% of these patients were still alive and 90% of the survivors were leading active and independent lives. "This outcome is extremely positive," said Dr. Lachapelle. "It proves that age alone should not be a factor in ruling out this type of surgery: feasibility must be assessed by a surgeon based on the patient's overall state of health."
Quality of life is a major concern for octogenarians, a growing segment of the Quebec population. It is therefore important to evaluate all possible treatments according to each patient's specific needs and limitations in order to provide everyone with the best possible care. "Pediatricians account for children's specific needs, as they differ from those of adults. The elderly also have specific issues that must be objectively assessed and not considered based on pre-conceived notions," explained Dr. Lachapelle.
###
Dr. Kevin Lachapelle is a cardiac surgeon at the MUHC as well as a researcher in the Cardiovascular Diseases and Critical Care Axis of the Research Institute of the MUHC. He is also an Associate Professor in Surgery at the Faculty of Medicine of McGill University.
The McGill University Health Centre
The McGill University Health Centre (MUHC) is a comprehensive academic health institution with an international reputation for excellence in clinical programs, research and teaching. Its partner hospitals are the Montreal Children's Hospital, the Montreal General Hospital, the Royal Victoria Hospital, the Montreal Neurological Hospital, the Montreal Chest Institute and the Lachine Hospital. The goal of the MUHC is to provide patient care based on the most advanced knowledge in the health care field and to contribute to the development of new knowledge. http://www.muhc.ca/