Has anyone had side effects from the Heart/Lung machine?

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PhilCraun

I have been hearing all kinds of scary reports about the side effects of the heart/lung machine... things like permanent memory loss.

Does anyone have any comments?
 
A lot of people on this site joke about memory loss, call themselves "pump heads", but my impression is that it isn't really a major problem.

I had my AVR on 13 March this year and notice I sometimes find it more diffucult to remember names. But it is better than it was and I am still hoping for more improvement. In any case, you are younger than me and can probably afford to lose a few cells without too much bother.:)

I hope you will get more reassurance from other replies. This is a great site to ask all the questions you need to before your surgery. Do you have a date yet. Everyone says the waiting time is the worst, from then on you're just watching things getting better.

Keep in touch.
 
I hate to disagree with Gillian but it is an issue to some. We joke because most of us have really positive attitudes and it is easier to make light of a subject. I, as many others, have experienced some form of memory loss but it is generally short term and most of the stuff you forget comes back later. Hell, at most of our ages, we have CRS anyway (can't remember s#!t).

In the grand scale of the possible complications that can arise from valve replacement surgery, I believe most of my mechanical valve buddies will go along with the statement that this is not one of the biggies.

I have an article on the subject that I will email to you Monday. It is not on my PC here at home. Some dispute the findings but I dare to say most of those have not had the problem to the extent many of us have experienced. Again, while I was aware of it, it was not really a concern to me. I eventually found all the stuff I could not find and remembered the words to the songs I have sung all my life (well most of them anyway).
 
Heart Lung Machine Side Effects

Heart Lung Machine Side Effects

Phil, Scientific case studies show that there is some decrease in mentation post pump but in almost all cases it is temporary- all gone by three months.I was on the pump one hour and twenty three minutes. This is about average. I have a buddy who had a mitral valve repair and was on only 58 minutes. I am 75 and have my senior moments but my wife reminds me that I had them before the surgery. I have gone back to work where I have to remember a lot and don't have any difficulty.Be positive and try to read and keep your mind active in the post op period.At my fitness center there are a dozen guys and gals who have had open heart surgery and they are as sharp as they can be. You will do well.
 
Not to worry, Phil. There have been studies done and it is supposed to be temporary.(Dr Rich over in About.com has written an article explaining it). It has to do with cognitive memory. I had bypass, not valve replacement. I find that common words are sometimes just not there, but somebody always supplies it, like the other day Gillian told us Jonathan had broken his elbow and in my post I referred to it as his leg!! It is no major thing for me. Things really important I need to remember are there.

From reading posts in here, haven't found anyone here that feels they have a REAL memory problem, tho we do poke fun at ourselves.
 
Phil

Phil

I'll echo the others. At first I found I didn't care to sit and read or knit for hours on end like I did before and do now...would get tired of it. Later in the summer (my surgery was in Jan.) when I started riding my motorcycle I noticed a visual or spatial problem when taking the curves. I'd lose my focus and chicken out...and my passion is taking curves as fast as I can...I wish I could lay it down like my husband...never have and never will til I get to the big curves upstairs...there's got to be motorcycles and neat winding roads up there. This summer all seems back to normal...maybe it was my sense of mortality from the surgery or something else, but it was temporary.
 
Hi Phil

A factual side-effect of the heart lung machine is that it damages your red blood cells. However, over time, we tend to replace them and get ourselves back to normal.

The effect of the h-l machine is time related, that is, a function of how long one is hooked up to it. Anecdotal evidence suggests that we do lose brain cells whilst on the machine, but I understand we all have many more than we need.

Best regards
 
Dick's article

Dick's article

I'd like a copy of the article Dick.

I don't think I really had a big problem with memory loss.

However if you ask my husband and kids........ You may get a different answer. lol
 
Here it is:

The New England Journal of Medicine -- February 8, 2001 -- Vol. 344, No. 6

Longitudinal Assessment of Neurocognitive Function after Coronary-Artery Bypass Surgery
Mark F. Newman, Jerry L. Kirchner, Barbara Phillips-Bute, Vincent Gaver, Hilary Grocott, Robert H. Jones, Daniel B. Mark, Joseph G. Reves, James A. Blumenthal, for the Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators

Abstract
Background. Cognitive decline complicates early recovery after coronary-artery bypass grafting (CABG) and may be evident in as many as three quarters of patients at the time of discharge from the hospital and a third of patients after six months. We sought to determine the course of cognitive change during the five years after CABG and the effect of perioperative decline on long-term cognitive function.
Methods. In 261 patients who underwent CABG, neurocognitive tests were performed preoperatively (at base line), before discharge, and six weeks, six months, and five years after CABG surgery. Decline in postoperative function was defined as a drop of 1 SD or more in the scores on tests of any one of four domains of cognitive function. (A reduction of 1 SD represents a decline in function of approximately 20 percent.) Overall neurocognitive status was assessed with a composite cognitive index score representing the sum of the scores for the individual domains. Factors predicting long-term cognitive decline were determined by multivariable logistic and linear regression.
Results. Among the patients studied, the incidence of cognitive decline was 53 percent at discharge, 36 percent at six weeks, 24 percent at six months, and 42 percent at five years. We investigated predictors of cognitive decline at five years and found that cognitive function at discharge was a significant predictor of long-term function (P<0.001).
Conclusions. These results confirm the relatively high prevalence and persistence of cognitive decline after CABG and suggest a pattern of early improvement followed by a later decline that is predicted by the presence of early postoperative cognitive decline. Interventions to prevent or reduce short- and long-term cognitive decline after cardiac surgery are warranted. (N Engl J Med 2001;344:395-402.)
Source Information
From the Department of Anesthesiology (M.F.N., J.L.K., B.P.-B., V.G., H.G., J.G.R.), the Department of Surgery (R.H.J.), the Division of Cardiology (D.B.M.), and the Department of Psychiatry and Behavioral Science (J.A.B.), Duke University Medical Center, Durham, N.C. Address reprint requests to Dr. Newman at the Division of Cardiothoracic Anesthesia, Box 3094, Duke University Medical Center, Durham, NC 27710, or at [email protected].
The members of the study groups are listed in the Appendix.
Appendix
The members of the Neurologic Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators of the Duke Heart Center were as follows: Director: M. Newman; Codirector: J. Blumenthal; Anesthesiology: F. Clements, N. de Bruijn, K. Grichnik, H. Grocott, S. Hill, A. Hilton, J. Mathew, J. Reves, D. Schwinn, M. Stafford Smith, A. Grigore, M. Gamoso, G. Mackensen, R. Panten, T. Stanley, L. Ti, J. Kirchner, A. Butler, V. Gaver, W. Cohen, B. Funk, M. Tirronen, W. White, and B. Phillips-Bute; Behavioral Medicine: J. Blumenthal, M. Babyak, and P. Khatri; Neurology: C. Graffagnino, D. Laskowitz, A. Saunders, and W. Strittmatter; Surgery: R. Anderson, T. D'Amico, R. Davis, D. Glower, R. Harpole, J. Jaggers, R. Jones, K. Landolfo, C. Milano, P. Smith, and W. Wolfe; Cardiology: D. Mark, E. Peterson, M. Sketch, and R. Califf.
Related Editorial

The full text of Original Articles is available to subscribers only after logging on. However, you can order the complete article.

Table of Contents | Previous Article | Next Article

Copyright © 2001 by the Massachusetts Medical Society. All rights reserved.
 
Mental Decline After Coronary-Artery Bypass Surgery

Mental Decline After Coronary-Artery Bypass Surgery

http://www.coloradohealthnet.org/CHNReports/mentaldecline_bypass.html?printit

Mental Decline After Coronary-Artery Bypass Surgery

Longitudinal Assessment of Neurocognitive Function after Coronary-Artery Bypass Surgery, by Mark F. Newman, Jerry L. Kirchner, Barbara Phillips-Bute, Vincent Gaver, Hilary Grocott, Robert H. Jones, Daniel B. Mark, Joseph G. Reves, James A. Blumenthal, for the Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators; The New England Journal of Medicine, February 8, 2001; Related Editorial, Coronary-Artery Bypass Surgery and the Brain, by Ola A. Selnes, Ph.D. and Guy M. McKhann, M.D., Johns Hopkins University.


Background
Here is the important background information that the authors give us:

cognitive or mental decline is recognized as a complication after cardiac surgery,
the incidence of the mental decline has changed little over the past 15 years despite advances in techniques for anesthesia, surgery, and the protection of organs,
elderly patients are at substantially increased risk for mental decline after surgery,
many clinicians have minimized the importance of post-operative mental decline because the decline appears to be transient in a substantial number of patients,
yet, in many patients, the decline has been shown to persist for at least 6 months. No studies have measured the course of the decline over a long term.

Purpose of This Study
The authors undertook this study to determine the course of mental change during the 5 years after coronary-artery bypass surgery.

Participants and Methodology
A total of 261 patients undergoing elective coronary-artery bypass surgery at the Duke Heart Center from March 1989 through November 1993 were enrolled in the study. The patients were given a brief set of neurocognitive tests before surgery, again on the day before discharge, and at 6 weeks, 6 months, and 5 years after their surgery. The tests measured the ability of the patients to:

repeat in numerical order a series of numbers presented to them orally and then to repeat the numbers in reverse order,
reproduce from memory a series of geometric shapes,
reproduce randomly generated numbers matched with symbols, and
connect with a line a series of numbers and letters in sequence.
These 4 factors represent the mental domains for verbal memory and language comprehension; abstraction and visuospatial orientation; attention and concentration; and visual memory. Mental decline was defined as 1 standard deviation in performance in any 1 of the 4 domains. One standard deviation represents a 20% decline in function.


Results
Here is what the study found:

mental decline was found in 53% of the patients at discharge,
the incidence of decline decreased to 36% at 6 weeks and 24% at 6 months.
but, 5 years after surgery, the incidence of mental decline increased to 42%,
those patients who did not have early postoperative mental decline, also did not have long-term decline,
in contrast, the patients who did have early postoperative decline, also had a long-term decline that was similar to that at discharge.

Authors? Summary and Conclusions
The authors summarize their findings as follows: Patients whose mental function declines immediately after surgery are at increased risk for long-term mental decline and a reduced level of overall mental functioning. Moreover, certain patients are at greater risk for early postoperative mental decline than others. In this study, patients who had early decline were more likely to be older and have a lower level of education than those who did not have early decline.
The authors suggest that patients who have early cognitive decline may be candidates for aggressive intervention strategies to prevent the late cognitive deterioration that this study documents.


Related Editorial
The authors of the editorial note that stroke and postoperative delirium are two of the more serious mental complications of coronary-artery bypass surgery. Postoperative delirium occurs after coronary-artery bypass surgery in about 10-30% of patients and may be related in part to anesthesia.
The editorial also suggests that the late decline in mental performance may be related to the surgical procedure itself. For example, in some patients, manipulation of the aorta during the surgery releases clots that can occlude vessels in the brain.

They urge that patients undergoing coronary-artery bypass surgery would benefit from postoperative changes in their diets, medications, and lifestyle.


Ed Asks: What Should You Do With This Report?
If you are about to undergo elective coronary artery bypass surgery, you should take this article to your doctor, surgeon, and anesthesiologist and ask which protective procedures are most appropriate for you. If, after surgery, you are found to have cognitive decline, you should ask about changes in your diet, medications, and lifestyle that may protect you against later decline.
 
I must admit, I've been getting a lot of mileage out of excusing myself for being a 'pumphead' and will probably continuing milking it to the hilt as long as I can! However, the effects really have been minor even though I was evidently on it for a relatively long time. From my own experience and what I've heard from others, it is probably more comparable to being just a tiny bit tipsy than it is to being really drunk!

Hope your experience with it goes as well as it has for me. Good luck.
 
I ditto the others. I had some memory loss at first(MVR & AVR March 8, 2001) but then it seemed to get better. When I first got home from the hospital, I't took me 15 minutes each morning to take all my meds because my brain didn't seem to be functioning on what I was doing. I also had one real scary mishap at about 6 weeks postop when I accidently left a cast iron skillet on the stove burner for 3 hours ( I was drying it) I went out to dinner and completely forgot the burner was on. The house was just getting a burnt singed smell in the air when I returned. There was a pan on the back burner that had plastic handles and it was just starting to melt. I haven't had any more mishaps like that. I had never done anything like that before in my life. I hope this helps though, to be on the alert. I definitely am now!

Lorraine
 
Hi Phil,

I did not have any problems at all regarding memory problems after surgery. At least none that I remember. LOL
Seriously though I am a 48 year old college student and I had my surgery April 5th this year. Four weeks after surgery I was back at school taking finals for the spring semester and even with missing the last four weeks of class's I got A's in all class's and made the deans list again with a 4.0 GPA for the semester. I like everyone else jokes about being a pumphead but in reality have no problems with it. I do have a hard time remembering names but then I have always been lousy at names anyway.
I would not spend a lot of time worrying about the effects of the pump, you will in all likelyhood be fine.
 
? pumphead

? pumphead

Phil, I think the reason you had no perceptible decrease in mentation is you are young and also in a challenging stimulating environment. The Duke article seems to validate this. Even though I am old, 75, I started reading immediately after the surgery, had some double vision but kept right on and then went back to work. I think doctors should get their patients brains challenged as soon after surgery as possible and this will cut down both early and late problems.
 
Pumphead

Pumphead

Phil,

I had AVR on 6-19-01 and I'm 38 years old.

I am now 3 weeks post-op and the only thing that I can tell you is that for the first week I had the attention span of a 2 year old. It wasn't that I couldn't remember things if I needed to, but I couldn't seem to stay on one task or do more than one thing for very long. Talking on the phone with the TV on was a big challenge. After that, things got back to normal. I haven't noticed any memory lapses or anything else out of the ordinary.

Hope this helps.

Kristy W.
 
heart lung side effects

heart lung side effects

Hi Phil,
avr 4/97 - st judes mechanical. I still remember not being able to concentrate on tv, newspapers - reading a book was impossible. It took a few weeks to gradually be able to concentrate more. I started doing crossword puzzles to make my mind work again. My memory has always been bad, so I can't blame the h-l machine for that although I do sometimes.
Sharon
 
After reading everybody's posts, seems lots of us had some sort of reaction. Here's what I did to help myself. After a month's stay with my nurse cousin, I came home, sat down at this wonderful machine and decided to learn as much as possible about it - before that it was little used, except for e-mail and games. There is a world of information to learn from it. I found this site and another one about heart disease and cardiology that way. It was a challenge but I loved every moment of it. Mental challenges will help all of us to remember and to learn, whether we are pump heads or not. God bless.:D
 
Thanks to Dick and Ken for supplying proof that the machine does do a number on us.

I've now had two AVR's and noticed no difference aside from week one post-op when the body is loaded with drugs.

I liked Marty's take on this. Your brain needs exercise just as your body.

I'm three weeks post-op and have read about six books since my surgery. I won't say my mind is at its peak of sharpness, however, I feel pretty normal and in fact, without any nasty work stuff to stress me out, my head is more clear than when I went in!

Based on the research shown by Dick and Ken and some of the experiences discussed here, it does sound like this can be a problem.

I am thankful I haven't felt the effects.
Kev
K
 
Alot of us do joke about it. And some of us will swear that we have some substantial memory loss, but it is my oppinion that most of the problems we have are medication related.
RobThatsMe encouraged me to get off of the Metoprolol and be switcvhed to something else. Well I never switched but my dosage is way down and My so called memory loss is improving.
Is there some truth to the memory loss, I think a little. But the so called study that was recently completed was done on patients in their 60's. No offense to any one in that age group, but memory capabilities do begin to fade around then for some. So I would say to wait until the medical community decides to do a study on all age groups before they make widee range statments regarding permanent effects.

Anyhow,

God Bless

Ben
 
Ben, I completely disagree with your analysis of my, and others, problem of memory loss. Many experience significient short term memory loss from the machines of which many seem to recover over time.

I do not see what the big issue is here unless we are trying to convince people fixing to undergo the procedure that all is rosey. For many it is but for many, there are complications. This is serious stuff.

I think it best to let people speak for themselves and give them credit for being able to explain their own issues. It is a "walk a mile in my shoes" kind of thing.

As one who experienced significient memory loss, I take offense at anyone trying to convince me otherwise. I had it, it is mostly over, **** happens, end of story.
 

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