Ilona Warf's blog ::...Nevertheless, the very next year, the National Cholesterol Education Program at the U.S. National Heart, Lung and Blood Institute issued new recommendations that drastically ...
Perhaps the heart-lung machine is innocent after all, when it comes to the cognitive decline in patients following coronary bypass surgery and other heart surgeries. For quite some time, the heart-lung machine has been blamed for cognitive issue such as short-term memory problems and personality changes in patients immediately after bypass surgery and other cardiac procedures. Studies have compared patients who underwent the cardiopulmonary bypass (heart-lung machine) with those who did not, and correlations in cognitive deficits were observed, with patients who'd been on the heart-lung machine showing more cognitive or neurological deficits than those who had "off-pump" surgery. Furthermore, cardiopulmonary bypass causes release of inflammatory responses throughout the body that can reach the brain, and also, the device causes "emboli" (including micro-bubbles and possibly tiny bits of plaque) that may infiltrate the blood and these may find their way to the brain. Circumstantial evidence has also strongly hinted that the heart-lung machine can impair mental functioning, in that patients who were perfectly normal before surgery, were not only off-kilter mentally post-operatively, but in some of these patients, their sudden post-op confusion, apathy, lack of focus, and short-term memory problems never disappeared. As strong as all this evidence seems to be, Johns Hopkins research insists otherwise, after studying 227 heart bypass surgery patients. Cardiac surgeons and brain scientists in the study reveal that cognitive problems and long-term memory issues are the result of the coronary artery disease itself, rather than side effects of the heart-lung machine. Says lead study author Ola A. Selnes, Ph.D., a professor in the Division of Cognitive Neuroscience in the neurology department at the Johns Hopkins University School of Medicine: "Our results hammer home the message that heart-lung machines are not to be blamed for cognitive declines observed years later in people who have had bypass surgery." This new evidence opposes previous findings that heart-lung machines caused side effects that have been dubbed "pumphead," meaning temporary memory problems and confusion immediately post-op in many coronary bypass patients. Patients and even doctors connected the dots and concluded that these problems stemmed from the heart-lung machine. But the Johns Hopkins research indicates that heart disease, not the heart-lung machine, is responsible for cognitive problems. Nevertheless, it is not well-understood how heart disease impacts cognition. More research, including brain imaging studies pre-op and post-op, is warranted. Interestingly, prior research has shown that about half of people who are scheduled for bypass surgery already have some degree of early brain damage. The Johns Hopkins study results appear in the August 2009 Annals of Thoracic Surgery. The data shows no disparity in brain deficits in patients who had bypass surgery, and this includes 75 patients who were operated off-pump, and 99 who chose drugs and stenting for treatment. However, all 326 patients were found to have substantial cognitive deterioration over the six-year study time period, when compared to 69 people with healthy hearts who had no known risks for coronary arterial disease. Despite these compelling findings, I have a glaring question: How do you explain the cognitive issues that arise immediately after a heart-lung bypass operation, that linger for months afterward, and especially that remain permanent, in that more than a year later, even several years later, there is no improvement? If this is the result of heart disease, then how come these cognitive issues were absent prior to surgery? How could they be missed prior to surgery if they were there? We're talking very obvious mental issues, not subtle ones. These include reports from the bypass patients themselves, claiming that ever since their surgery, they've been incapable of handling higher executive functions, among other cognitive activities. And these immediate, post-op concerns persist. What triggered these? To see what I mean, check out the following article, and its many comments at: http://www.scientificamerican.com/article.cfm?id=pumphead-heart-lung-machine Source: http://www.sciencedaily.com/releases/2009/08/090803132750.htm |
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