On-pump surgery. What is your experience/advice?
Post-Perfusion or "Pump Head" Syndrome and mental decline after open heart "on-pump" surgery. My 82-year old husband will soon be having open heart surgery, with an aortic valve replacement, and two bypasses. He has had two TIA's in the past. The alternative of no surgery is dismal, and his symptoms are worsening quickly. So far, no congestive heart failure. We've read about slow re-warming after surgery, and also the "cell saver", but don't know how to broach this with a major heart research hospital, and surely don't want to insult any surgeon by questioning their technique. I'd appreciate any knowledge, experience, or opinions, as candid as possible. My husband would rather deal with brutal reality than pipe dreams, and has accepted that surgery is required. He has been rejected for the minimally invasive TAVR, because he is otherwise too healthy.
So yes, do the surgery, at the best hospital, with the best surgeon you can find. We did an artificial valve, the warfarin has not been an issue. He has a self test machine. Let us know when this is scheduled so we can think good thought and pray. Smothers sailing to you both!
To our delight today, we found some hopeful information that supports what the three surgeons have told us:
2013 Physician’s Weekly article summarizes Johns Hopkins comparative study with control groups:
physiciansweekly/cabg-neurologic-cognitive-effects/
2013 CABG Surgery Generally Not Associated with Long-Term Cognitive Dysfunction
sts/news/cabg-surgery-generally-not-associated-long-term-cognitive-dysfunction
The surgeons each have told us my husband has a 50-60% chance of sudden death within six months without the surgery. Our son-in-law is a cardiac surgeon and admonishes that my husband is doing more damage to his brain by NOT jumping into open heart surgery. We’ve even explored letting nature take its course, but both feel that is unacceptable with a 70% chance of recovering fully after open heart surgery. You are so right that we should be asking the surgeons/anesthesiologists, and indeed we will. I’m just insecure because answers seem to point to the fact that at this time, there is a Russian Roulette quality to our decisions. A friend of mine who had an emergency quadruple bypass and was in a coma for over one month says she was “lucky” because she didn’t have to make any decision. She’s doing great, but is only 63. Yes, I couldn’t help just reaching out to see if others have had experience dealing with this, working through the gut-wrenching decisions, and aftermaths. Thank you all so very much.
Apparently Medicare will not approve TAVR for “moderate” surgical risks. My husband is clearly “moderate.” Though advanced age is one factor in the scoring algorithm (which crunches all the patient’s data which has been entered into a huge database administered by CMS/Medicare), the rest of his general health is “like a 60 year old.” The same TAVR Center also has a clinical trial going on that will take “moderates” for a 50-50 chance at TAVR, but you can’t choose the technique as it is randomized. They will let us know tomorrow if he is admitted into the randomized study.
From our layman’s research, it seems the incidence of need for re-surgery after TAVR can be higher than with open heart, but I’m sure there are fee-based studies that show otherwise that you can’t get at on the open Internet. Because TAVR uses the old calcified valve to hold the new valve, there can be risk for leakage, poor placement, and debris breaking off the calcified valve. Seems weird to compress a rotten old valve with a new one, but then again any new valve is a foreign substance.
To our delight today, we found some hopeful information that supports what the three surgeons have told us:
surgeon.
I would make sure that your husband understands and signs off in some manner on a commitment to do rehab after surgery. My mil, who was 80 at the time of a similar surgery for aneurysm repair, simply refused to do any rehab.
He is "too healthy" for a TAVR? That doesn't sound right. He is 82 years old, and TAVR was made for elderly folks who would not fare well after an open chest procedure.
You have a lot of questions about this----why would you not ask the doctors to answer them? A teaching hospital is exactly that----and "teaching" is not just about training the residents. You have every right to ask questions & demand answers, and also every right to question a surgeon's technique & why the surgeon is using that technique as opposed to another technique. With something like this, it also does not hurt to get a second opinion from a surgeon not associated with the same hospital as the surgeon you are going to now.
If I were you, I would want to know what grade the aortic stenosis is, which coronary vessels are blocked & what percent of blockage, and why the procedures cannot be done via a catheter instead of an "open chest" procedure, which will be far more difficult to recover from for an 82 year old. The advantages of doing valve replacements & placing stents through catheters is that it is far less invasive than an open procedure & therefore the recovery is much faster & much easier.
I would not accept the opinion of one surgeon, if he/she says that they cannot or will not perform the procedures via catheter. Putting an 82 year old person with a medical issue such as aortic stenosis through an open chest procedure is EXTREMELY risky. I would actually look for a surgeon that would do it via catheter. You say that your husband isn't in congestive heart failure yet, so you have time.
If you feel self-conscious about asking questions or are worried about "insulting" a surgeon, then you are uncomfortable with the whole thing. Find a cardiothoracic surgeon that will answer your questions & explain the whole procedure to you.
{Q}Cognitive impairment does indeed occur after bypass surgery. This study should move the existence of this phenomenon from the realm of locker room speculation to the realm of fact.{EQ}
I had multiple bypass surgery 2007 at MGH. Ignorance is bliss.
Second, watch carefully after the surgery and follow up promptly on any new symptoms.
After his on-pump surgery three different doctors over the next year told my friend's husband he should be on an antidepressant. He refused. My friend was going nuts dealing with his personality changes. Finally he was hospitalized for something unrelated, they simply started him on antidepressants which he continued after release. It returned him to his former self! It was a shame they wasted more than a year to implement the solution.
Best wishes for optimum results!