Cognitive Impairment After Heart Bypass Surgery
For many years, in the surgeons locker room , cardiac surgeons would mention to each other a phenomenon they often referred to as pump head. Pump head was a term used to describe impairment in a mental capacity they sometimes noticed in their patients following coronary artery bypass surgery. It got this name because the presumption was that cognitive impairment after bypass surgery was related to the use of the cardiopulmonary bypass pump during the procedure.
For a long time, talk about this phenomenon never got far beyond the locker room.
In 2001, a study from Duke University seemed to confirm what many healthcare providers had long suspected, but had been reluctant to discuss openly. Namely, a substantial proportion of people after coronary artery bypass surgery subsequently experience measurable impairment in their mental capabilities. This study received a lot of publicity after its publication in the New England Journal of Medicine and caused a lot of concern among both healthcare providers and their prospective patients. But the worry quickly faded away, and the general public really hasnt heard much about it since.
While surgeons still may not like to talk about it publicly, post-bypass surgery cognitive impairment is common enough that people having this surgery and their loved ones ought to be made aware of it beforehand, so they are prepared to cope with it should it occur.
What To Do With The Emotional Side Effects Of Open
Emotional changes after heart surgery are not uncommon, and neither are periods of irritability and fatigue. Sometimes, changes in mood can be caused by medication for surgerys aftermath, and not the surgery itself. If mood changes persist, the first step is to speak to the doctor who performed the procedure. Those doctors will have seen these kinds of post-surgical problems before. Either they can advise what kind of treatment is needed, or they can refer you to someone who can provide more insight.
You May Experience Collarbone And Sternum Pain After Open
Sometimes you can have prolonged collarbone and sternum pain. Collarbone pain and sternum pain can be caused by the trauma of the surgery on your body or sternal wires. This pain can be sometimes helped with cardiac rehab or a resternotomy. However, make sure to communicate with your doctor about your pain to make sure its normal. After this past open heart surgery, Ive had a lot of pain and clicking in my shoulders and chest. Its caused a lot of chronic pain but working with physical therapy has helped me regain strength.
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Thanks Tom And Dr Khan
I hope this helped Tom learn more about Pumphead and the heart-lung machine.
Many thanks to Tom for submitting his question! A special thanks goes out to Dr. Junaid Khan and Sutter Health Alta Bates Medical Center for taking such great care of heart valve patients!
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Keep on tickin!Adam
P.S. For the deaf and hard of hearing members of our community, I have provided a written transcript of my interview with Dr. Khan below.
Gerard J Myers Rt Ccp Emeritus
Cardiovascular Perfusionist, Respiratory Therapist, International Speaker/Consultant, Author, Researcher, Artist
The discussion that follows here on postoperative delirium may be a matter of interest to readers concerned about understanding the term pump head after having undergone a cardiac surgical procedure.
As far back as 64 years ago in 1953, the first successful open heart surgery case was performed with the use of a heart lung machine. Today the use of this heart lung machine is referred to as cardiopulmonary bypass . It is well known that after having cardiac surgery, many patients will experience some form of memory loss, emotional stress or sluggish mental capacity. Many times its as simple as having a family member noticing that their loved one is different than they were before they had their heart surgery.
Unfortunately, for many years the label applied to these unexplained postoperative dysfunctions has been pump head. This is because in the earlier days of cardiac surgery the problem was assumed to be solely related to the heart lung machine and because of the use of bubble oxygenators, which are no longer used for CPB. In fact, for many years pump head was the term used by the medical community to describe the problem of postoperative confusion to their patients and the media.
So what are Neurocognitive Dysfunctions?
Jonas RA. Neurological protection during cardiopulmonary bypass/deep hypothermia – Pediatr Cardiol 1998 19: 321-30
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What About Pumphead After Heart Surgery Asks Tom
Written By: Adam Pick, Patient Advocate & AuthorPublished: November 3, 2022
I received a great question from Tom about Pumphead after heart surgery. In his email to me, Tom asked me, Hi Adam, What is the truth about Pumphead? I have read conflicting reports about whether or not the heart-lung machine is potentially responsible for post-operative cognitive issues including confusion, anxiety, and forgetfulness.
To provide Tom an expert response to this important question, I contacted Dr. Junaid Khan, a leading cardiac surgeon at Sutter Health Alta Bates Summit Medical Center in Oakland, California. During his career, Dr. Khan has performed over 4,000 cardiac procedure with more than 2,000 operations involving heart valve repair and replacement operations.
Bill Clintons Madness: A Consequence Of Heart
12-Day McDougall Programconsultations Learn more
We Need to Understand and Show Some Compassion
One of the savviest politicians of our generation, known for his wit, charm, and calm under extreme pressure, Bill Clinton appears out of character in the speeches and interviews televised since his bypass surgery September 6, 2004 and his mental deterioration may be accelerating. Remember, this is the president who withstood public impeachment before the entire world for his relationship with Monica Lewinski without once losing control. Now, he is easily angered by hecklers, and makes factual mistakes and racial slurs while aggressively defending his wifes campaign for presidency. Everyone sees his mental and emotional decline, yet to date, no medical professionals have spoken out about the cause or offered help.
Our former president needs our understanding and support. A simple explanation by his doctors of the cause of his recent aberrant behaviors should bring peace of mind to Hillary and her campaign staff. If Mr. Clinton better understood his current limitations, he and his staff could take precautionary steps to avoid embarrassments. A long-overdue explanation would help his adoring public more easily accept his mistakes and readily forgive him. It is not your fault, Mr. Clinton.
John McDougall, MD
1) Hill JD, Aguilar MJ, Baranco A, de Lanerolle P, Gerbode F. Neuropathological manifestations of cardiac surgery. Ann Thorac Surg. 1969 May 7:409-19.
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When To Call The Doctor
- You have chest pain or shortness of breath that does not go away when you rest.
- Your pulse feels irregular — it is very slow or very fast .
- You have dizziness, fainting, or you are very tired.
- You have a severe headache that does not go away.
- You have a cough that does not go away
- You are coughing up blood or yellow or green mucus.
- You have problems taking any of your heart medicines.
- Your weight goes up by more than 2 pounds in a day for 2 days in a row.
- Your wound changes. It is red or swollen, it has opened, or there is more drainage coming from it.
- You have chills or a fever over 101°F .
Which Is Better On
Scientists are still studying the long-term benefits of off-pump surgery compared to on-pump surgery. Your surgeon will help you decide which is best for you.
On-pump CABG provides a surgical area thats still and free of blood for better stability and visibility.
But off-pump bypass surgery may involve a smaller incision, shorter hospital stay and faster recovery. It may also reduce the risk of certain postsurgical complications:
- Cognitive problems such as memory loss.
- Size of the incision.
In general, youll:
- Begin to drink fluids and eat small amounts of food the same day or the day after surgery.
- Sit in a chair and walk with some help in the first day or two.
- Stay in the hospital for several days.
- Need help at home for the first several days after hospital discharge.
- Get stitches and staples removed in a week to 10 days.
- Have to avoid lifting anything for several weeks.
- Recover fully in several weeks or more.
- Participate in a cardiac rehabilitation program to help rebuild your strength.
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Who Needs To Have Off
Off-pump bypass surgery is a treatment option for coronary artery disease .
In a person with CAD, plaque builds up in the arteries, restricting or blocking blood flow. It can cause symptoms like chest pain and shortness of breath. A completely blocked artery can lead to a heart attack.
Severe cases of CAD that dont respond to lifestyle changes, medications and other procedures may require bypass surgery. It can improve symptoms, reduce the risk of a heart attack and improve survival. Off-pump bypass surgery is an option for some people who choose CABG.
You May Experience Memory Loss And/or Brain Fog
There are a couple of things that can cause memory loss and brain fog after open-heart surgery. If you were put on bypass, it can cause these issues. It is also called pump head. Post-operative cognitive dysfunction can also cause memory loss. Both of these are usually short-term but can have the possibility of long-term effects. For the first six months, I really struggled with memory loss and brain fog. As time went on, it started to get better and I started to regain my memory and wasnt so foggy-headed.
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Postoperative Cognitive Dysfunction And Cardiac Surgery
POCD follows both cardiac and noncardiac surgery. When patients are tested at hospital discharge or at 1 week after the procedure, the incidence of POCD is higher after cardiac surgery than noncardiac surgery . Up to 43% of patients have POCD at 7 days after coronary artery bypass graft surgery . By 3 months and 12 months after the procedure, however, there is no significant difference in the incidence of POCD regardless of the type of surgery or anesthesia. In a prospective investigation using RCI to diagnose POCD in three patient populations , the incidence of POCD at 3 months was 16%, 17%, and 21%, respectively . Despite the great variation in the magnitude of surgery and type of anesthesia, any difference in the incidence of POCD at 3 and 12 months was indistinguishable. When viewed in comparison with the incidence of POCD after 1 week in the cardiac group, this suggests that testing at 1 week after surgery may be identifying a phenomenon arising from a different mechanism. Thus, the likelihood is that early POCD is largely a different entity to later POCD.
Neurocognitive Deficit As A Consequence Of Vascular Disease
A study by McKhann et al. compared the neurocognitive outcome of people with coronary artery disease to heart-healthy controls . People with CAD were subdivided into treatment with CABG, OPCAB and non-surgical medical management. The three groups with CAD all performed significantly lower at baseline than the heart-healthy controls. All groups improved by 3 months, and there were minimal intrasubject changes from 3 to 12 months. No one consistent difference between the CABG and off-pump patients was observed. The authors concluded patients with long-standing coronary artery disease have some degree of cognitive dysfunction secondary to cerebrovascular disease before surgery there is no evidence the cognitive test performance of bypass surgery patients differed from similar control groups with coronary artery disease over a 12-month follow-up period. A related study by Selnes et al. concluded patients with coronary artery bypass grafting did not differ from a comparable nonsurgical control group with coronary artery disease 1 or 3 years after baseline examination. This finding suggests that late cognitive decline after coronary artery bypass grafting previously reported by Newman et al. may not be specific to the use of cardiopulmonary bypass, but may also occur in patients with very similar risk factors for cardiovascular and cerebrovascular disease.
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Personality And Emotional Side Effects Of Open
People who have had open heart surgery report mood changes, as do people close to them. Anxiety and depression are the most commonly experienced emotions after heart surgery. Anxiety can be caused, in part, by worries about possible physical aftereffects of the surgery. Keep in mind that full recovery from open heart surgery can take up to one year.
Your Personality And Mood May Change After Open
After open-heart surgery, many people experience personality and mood changes. The most commonly experienced emotions are depression, fatigue and anxiety. These can be caused by being on bypass, anesthesia, or medication such as oxycontin. You may experience mood swings like crying or getting angry or easily frustrated.
I mostly experienced this after my second open heart surgery when I was a teenager and my third open-heart surgery. After both of them, I experienced depression, anxiety and PTSD. Before my second open heart surgery, I was more outgoing but afterward, my personality changed and I was quieter and self-reflective. I struggled with suicidal thoughts and mood swings. After my most recent surgery, I finally got the therapy I needed after years of not seeking help. If you are struggling, please find help, be open with your doctor and make sure you have someone to talk to.
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Dealing With The Problem Of Pump Head After Bypass Surgery
New York, NY – Does bypass surgery sacrifice patients’ minds as it saves their hearts? Sometimes, according to experts and patients quoted in a New York Times feature story on September 19, 2000. “Doctors say evidence is mounting that a small but significant number of bypass patients suffer some degree of cognitive impairment, like memory and attention deficits and language problems, particularly if they spend time on heart-lung machines. These patients are apart from the approximately 2% to 5% of patients who suffer strokes after bypass surgery, a procedure 600000 Americans undergo each year. It is unknown how many patients suffer the less catastrophic, but nevertheless debilitating, cognitive problems. Depending on how the problem is defined, studies suggest that anywhere from 10% to 50% or more of bypass patients do poorly on tests of memory, language and spatial orientation six months after surgery. These changes can persist years after surgery, and in many cases are probably irreversible,” writes Sandeep Jauhar. The “pump head” problem costs an estimated $1 billion a year, he reports.
“As we operate on older and older patients, because of theaccumulated burden of disease in their blood vessels, we’re seeing moreneurological injury”
“A high-functioning 75-year-old who I might normally bevery aggressive about bypassing, I might try to manage medically or withangioplasty”
What Causes Cognitive Impairment After Bypass Surgery
The exact cause of cognitive impairment following bypass surgery is unknown. There are probably several factors that can bring it about.
Originally it was presumed to be caused by small blood clots to the brain associated with usage of the heart-lung bypass pump. However, more recent studies have shown that employing more modern, off-pump bypass surgery has not reduced the incidence of cognitive impairment.
The theory that has the most traction today is that the manipulation of the heart and aorta can generate tiny blood clots, called microemboli, that can travel to the brain and cause damage there . Intraoperative studies using transcranial Doppler techniques have confirmed that showers of microemboli to the brain are common during bypass surgery, and other studies using pre-and-post-operative MRI scans have shown tiny ischemic lesions in the brains of people who experience cognitive decline. However, even these studies have yielded mixed results, and the causative role of microemboli is not yet proven.
Other potential causes, such as drops in blood pressure, hyperthermia , and a prolonged reduction of oxygen levels in the blood, all of which can occur during heart surgery or immediately postoperatively, may also play a role.
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Predicting Stroke And Other Risks
Although CABG surgery seems not to be the cause of cognitive decline in cardiac patients, extra care may be necessary in patients who are at risk for stroke and other problems. Stroke occurs when an area of the brain does not get enough blood. Blood supplies oxygen, and the brain needs oxygen to function. Strokes can be caused by either a hemorrhage in the brain or the blockage of a brain blood vessel. Think of the analogy of a sprinkler system on a lawn: if one of the pipes in the system becomes clogged, that area of the lawn does not get water and eventually dries up and dies. A similar process occurs in the brain if a blood vessel becomes clogged and blood flow to a region of the brain is restricted.
Why are strokes associated with CABG and other forms of heart surgery? The most likely explanation is that during surgery, small bits of material, usually blood clots or bits of tissue associated with arteriosclerosis , break off and are carried through the bloodstream to the brain. There, they lodge inside blood vessels and eventually block blood flow to the brain. Stroke can also occur when blood pressure falls too low to pump enough blood to the brain. For these reasons, blood pressure is carefully monitored during surgery. In most people who suffer a stroke as a result of heart surgery, bits of material and low blood pressure seem to be working together to cause damage.
Your Brain And Heart Surgery
Some heart surgery patients have cognitive problems afterward, but the idea that the surgery causes these problems is misleading. Guy McKhann and Brenda Patoine reveal how brain health before surgery appears to be the key influence on brain health afterward recent findings suggest that the same problems affecting the arteries of the heart, pre-surgery, are also affecting the blood vessels feeding the brain. These findings have important implications for treatment options and how doctors inform patients of risks. Last but not least, they reinforce the idea that whats good for the heart is good for the brain, too.
Since the earliest days of cardiac surgeryunquestionably one of the great medical triumphs of the late 20th centurypost-surgery memory problems and mental fogginess have been observed in patients. Heart doctors even had a nickname for it: pump head. The slang referred to the heart-lung bypass machine that made the surgeries possible but was presumed to be the cause of the problem.
Fortunately, such short-term cognitive problems usually resolve within a few weeks by a year post-surgery, most people are back to normal. It is also not at all clear that the pump itself is the culprit, since cognitive problems are also associated with newer off-pump procedures.
As it turns out, this line of thinking not only oversimplifies a complex problem it may in fact be downright misleading.
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