Association between mild ascending aortic atherosclerosis and early cognitive function after on-pump CABG

Reyhancan A.

Cardiovascular surgery and interventions, cilt.13, sa.3, ss.152-159, 2026 (TRDizin)

Özet

Objectives

 Manipulation of an atherosclerotic ascending aorta during coronary artery bypass grafting (CABG) may release cerebral emboli. Moderate-to-severe aortic atherosclerosis has been linked to postoperative cognitive impairment. Whether milder degrees of ascending aortic atheroma carry a comparable early cognitive risk is unclear. We investigated the association between mild ascending aortic atherosclerosis on preoperative computed tomography and early postoperative cognitive function.

Patients and methods

 In this prospective comparative cohort study, 39 patients undergoing elective isolated on-pump CABG were classified by preoperative computed tomography into normal aorta (Group 1, n=17) and mild ascending aortic atherosclerosis (Group 2, n=22). The Montreal cognitive assessment (MoCA) was administered preoperatively and on postoperative day 7. The primary outcome was the between-group difference in MoCA change score, analyzed with adjustment for age and baseline cognition.

Results

Preoperative and postoperative MoCA scores were similar between groups (p=0.994 and p=0.838, respectively). Within-group change from preoperative to postoperative was non-significant in both groups (Group 1: -0.5±3.5, p=0.544; Group 2: +0.2±2.9, p=0.772). The between-group difference in change score was not significant (mean difference -0.71 points, 95% confidence interval -2.80 to 1.37; p=0.494; Cohen’s d=-0.22). After adjustment for age and baseline MoCA, the presence of mild atherosclerosis had no significant effect on postoperative cognition (β=-0.31; p=0.798; partial η2=0.002), with baseline MoCA the only significant predictor (p<0.001).

Conclusion

 In this prospective cohort, mild ascending aortic atherosclerosis was not associated with a large early postoperative cognitive effect after on-pump CABG, and this persisted after adjustment for age and baseline cognition. As the study was powered only to detect large effects, these findings should be regarded as hypothesis-generating, and larger studies spanning the full spectrum of aortic atheroma burden are needed.