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Komoda, T1; Drews, T1; Sakuraba, S2; Kubo, M2; Hetzer, R1

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Background: Among heart transplant (HTx) patients without a history of stroke, some patients show executive cognitive dysfunction after long-term mechanical circulatory support (MCS). Methods: Fifty HTx patients (19 patients on MCS longer than 3 months before HTx and 31 patients without MCS as control group) were enrolled in the study. All the subjects were men aged between 20 and 59 years without past history of stroke. The patients with MCS were divided into two groups: the AH-Thr group (n = 11), in whom a thrombus was detected in the left ventricular assist device (LVAD) and quickly removed (mean 3.3 times), and the AH group (n = 8) without detectable thrombus in the LVAD. The following tests were administered: the Trail Making Test (TMT) and the Wisconsin Card Sorting Test (WCST), both of which measure executive cognitive function, and the Mini-Mental State Examination (MMSE), which measures global cognitive function. Results: The MMSE scores were as follows: AH-Thr group 28.8 ± 2.0; AH group 29.9 ± 0.4; control group 29.4 ± 0.9 (mean ± SD). The completion times for TMT part B (sec) were as follows: AH-Thr group 49.7 ± 22.5 (p<0.05 vs. other 2 groups); AH group 30.4 ± 7.5; control group 31.5 ± 9.4. The perseverative errors in the WCST (counts) were as follows: AH-Thr group 20.3 ± 13.3 (p<0.001 vs. other 2 groups); AH group 5.0 ±1.4; control group 7.3 ± 2.7. These data indicate that patients in the AH-Thr group show executive cognitive dysfunction. Conclusion: The conditions that facilitate thrombus formation in the LVAD may induce executive cognitive dysfunction without stroke.

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