THE TREATMENT OR THE DISEASE?: Long blamed for post-op cognitive decline, the heart-lung machine may be off the hook as researchers learn more about the long-term impacts of vascular disease on the brain--not just the heart
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In the months after he had surgery to fix his defective heart valve, Bruce Stutz didn't feel quite the same. It wasn't his physical fitness that was subpar, although that did require some post-op retraining, but rather his mental capacity. "I couldn't muster the concentration to deal with the problem," he wrote in a 2003 article for Scientific American.
During surgery, Stutz had been hooked up to a heart–lung machine, also called a cardiopulmonary-bypass pump, for the two-hours of a procedure to keep his blood oxygenated and flowing while his heart was stopped. He found that he was not the only one who, after time on the pump, had felt their brains bogged down by simple tasks.
A 2001 study in The New England Journal of Medicine found that of 261 heart disease patients who had been kept alive during surgery with the pump, 42 percent showed cognitive decline five years after the surgery, even after adjusting for age. "Interventions to prevent or reduce short- and long-term cognitive decline after cardiac surgery are warranted," the authors, led by Mark Newman of the Duke University Medical Center, concluded. And a study published earlier this year in The Annals of Thoracic Surgery, led by James Slater, a cardiothoracic surgeon at the Mid-Atlantic Surgical Associates in Morristown, N.J., supported the previous findings, showing that lowered levels of oxygen in blood flowing to the brain during surgery did correlate to increased risk of suffering from the mental impairment dubbed "pump head".
But some noticed a flaw in these studies. Most that supported the pump head condition had focused only on patients who underwent pump support during surgery for coronary artery bypass grafting (CABG) but had not controlled for those with the disease who had different types of procedures, such as off-pump surgery or no surgery at all. Could there be something missing in the data?
That's what Ola Selnes, a professor of neurology at The Johns Hopkins Hospital in Baltimore, and his colleagues set out to find. Their six-year study—published this month in The Annals of Thoracic Surgery—examined 326 people who had coronary disease and 69 who didn't. Of those who did had the disease: 152 had undergone the CABG procedure using the pump; 75 had off-pump surgery; and 99 had nonsurgical treatment. After testing subjects at several intervals starting before surgery and ending six years later, they found that those with healthy hearts retained their levels of cognitive functioning after the operation, whereas the patients with coronary disease experienced about the same amount of cognitive decline—regardless of the sort of treatment they had. The results call into question years of assumptions about the long-term safety of the pump.
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17 Comments
Add CommentThis raises some interesting concerns for me, as I have a 3 yr. old son with tricuspid atresia who has already undergone 2 open-heart procedures and is due for a third when he is 5. What kind of an impact does this have on pediatric cardiology patients? Is there a possibility that procedures utilizing the heart-lung machine can cause developmental problems in these children that will surface in the years to come? I will definitely be conducting some research of my own now after reading this.
Reply | Report Abuse | Link to thisThe article was about how the heart-lung machine was found to not be the cause of so-called "Pump Head" Syndrome. Did you have cognitive decline while you were reading it?
Reply | Report Abuse | Link to this"those with healthy hearts retained their levels of cognitive functioning after the operation"
Reply | Report Abuse | Link to thiswhy do an operation on a healthy heart?
That "it takes this long to turn around a scientific opinion..." may have surprised Selnes, but it doesn't surprise me.
Reply | Report Abuse | Link to thisFor all their supposed objectivity scientists seem just like everyone else when it comes to holding opinions.
Maybe someone should do a study on that...
But simple anesthesia is also correlated with cognitive decline and Alzheimer's:
Reply | Report Abuse | Link to thishttp://dx.doi.org/10.1016/j.mehy.2006.08.030
http://dx.doi.org/10.1016/S0889-8537(05)70149-8
Here's the current info:
Reply | Report Abuse | Link to thishttp://www.anesthanalg.org/cgi/content/abstract/108/5/1627
and a possible mechanism:
Reply | Report Abuse | Link to thishttp://iospress.metapress.com/content/549m633456804l08/
This obsevation is not applicable to all cases. It appears that if the operation of the Heart Lung machine itself was not monitored adequately during the procedure leading to oxygen defeciency in the patients blood, brain cells could suffer resulting in pump head of those few unfortunate patients
Reply | Report Abuse | Link to thisI underwent aortic valve and cardiac by-pass surgery Sep 22, 2009, during which the heart lung machine was used; within 2 weeks I thought I had suffered a stroke, I experienced difficulty in hearing and speaking, my vision was extremely dark, I couldn't relate to numbers and simple math colutions, my driving has suffered with depth perception issues - I just discovered yesterday that I experienced the pump head syndrome - some of my problems have been minimized but I'm not 100% yet -I am deeply disturbed that his situation may be permanent.
Reply | Report Abuse | Link to thisI.m an 83 yr old radiologist still working half time.. Had mitral replacement in 1998. On pump for 75'. Preliminary angio showed no coronary disease. I had and still have had no signs of "pumphead". I'm thankful especially to my surgeon, my anesthesiologist, and the pump technicians.
Reply | Report Abuse | Link to thisI HAD A MITRAL VALVE REPAIR IN 1995 AT AGE 55
Reply | Report Abuse | Link to thisI WAS ON THE HART LUNG MACHINE
I CONSIDERED MYSELF LUCKY THAT THE VALVE WAS SAVED. 15 YEARS LATER ALL TEST INDICATE THAT MY HEART IS IN GREAT CONDITION
I HAVE HAD SEVERAL TYPES OF NERVOUS CONDITIONS SINCE THAT SURGERY THAT HAS SLOWLY GOTTEN WORSE AND I HAVE BEEN ON CLONAZEPAM FOR 13 YEARS BUT OVER THE PAST 2 YEARS IS OF LITTLE HELP AND I HAVE REFUSED TO INCREASE MY DOSAGE OG 3 MG DAILY
I NEED HELP AS THE DOCTORS SAY I AM FINE BUT HAVE CONTINUAL PROBLEMS OF GREAT UNEASYNESS
NONE OF THE DOCTORS WANT TO DISCUSS THE HEART LUNG MACHINE AND THE DAMAGE IT MAY HAVE CAUSED
SINCERELY
DAVID YAWITZ
WOULD LOVE TO HEAR YOUR OPINION OR KNOWLEDGE ON MY MATTER RELATING TO MY MITRAL VALVE REPAIR AND LATER PROBLEMS
Reply | Report Abuse | Link to thisIf it happens to you, its temporary. I h d a mitral valvuloplasty a few years back also because of childhood rheumatic fever (and am now facing valve replacement), and, although I appeared and sounded normal, I knew that my brain was a bit foggy. It lasted for 3 months, during which time I was generally thinking okay, and occasionally felt almost like brain tired. It only lasted three months, like I said, so dont worry. At least you know in advance that it might happen. See more details on <a href="http://www.ajtnt.com" >Trailers for Sale</a> and <a href="http://www.luxurysarasotarealestate.com" >Sarasota Real Estate</a>
Reply | Report Abuse | Link to thisI had mitral valve repair in March of this year. I too had read about “pumphead,” but never experienced it.
Reply | Report Abuse | Link to thisOn the other hand, I did experience depression, and in retrospect, would go on an antidepressant BEFORE the surgery to help alleviate that whole experience. My cardiologist told me, AFTER the depression had lifted, that he was taught in school to start open heart patients w/ antidepressants before their surgery, but in his practice now, he’s not “allowed” to prescribe antidepressant med prior to surgery. Yipes.
Good luck w/ your procedure. You’ll do fine. If you’ve ever had a scratched cornea, I’m here to tell you that that hurts way more than this surgery. See More details on <a href="http://www.ajtnt.com" >Trailers for Sale</a> and <a href="http://www.luxurysarasotarealestate.com" >Sarasota Real Estate</a> .
I find no non-cognitive problems discussed such as the effect on the parietal lobe and its 'balance' function. I had quintuple bypass in Jan 2006 and still suffer a balance problem.
Reply | Report Abuse | Link to thisThe first successful open heart procedure on a human utilising the heart lung machine was performed by John Heysham Gibbon on May 6, 1953. Heart Lung Machine's are used in following cases:
Reply | Report Abuse | Link to this*Coronary artery bypass surgery
*Repair of large septal defects(atrial septal defect, ventricular septal defect, AtrioVentricular septal defect)
*Cardiac valve repair and/or replacement(aortic valve,mitral valve, tricuspid valve, pulmonic valve)
*Repair of some large aneurysms(aortic aneurysms, cerebral aneurysms)
*Repair and/or palliation of Congenital Heart Disease(Tetralogy of Fallot, transposition of the great vessels)
*Heart or lung Transplantation
<a href="http://www.heart-consult.com/articles/what- heart-lung-machine">Link</a>
My 46 yr old husband had an aortic root replacement and valve replacement approx. 5 weeks ago due to a genetic defect. His heart was disease free and all coronary vessels were clear but he still has the symptoms of "pump-head". I think that there are exceptions in every study but I didn't notice any reference to that fact. I am looking for some kind of natural tx to help my husband get better before he just gives up and dies.
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