Pump Head

[boomersooner]

Did anyone here at VR.com experienced pump head after their surgery? This really freaks me out. There is a study by Duke that shows 42% of people that go on the heart and lung machine lose 20% of their cognitive capacity capabilities 5 years after surgery! Has anyone been told anything different by their surgeons or anything at all about pump head?

Thanks
Jared

 

[boomersooner]

Here is part of an article that I ran across while I was searching for answers about my memory problem, check it out and see what you think.

Pump Head: Mental impairment after bypass surgery

A study from Duke University, published in the New England Journal of Medicine in February, 2001, confirms what many doctors have suspected, but have been reluctant to discuss with their patients: A substantial proportion of patients after coronary artery bypass surgery experience measurable impairment in their mental capabilities. In the surgeons? locker room, this phenomenon (not publicized for obvious reasons) has been referred to as "pump head."

In the Duke study, 261 patients having bypass surgery were tested for their cognitive capacity (i.e. mental ability) at four different times: before surgery, six weeks, six months, and five years after bypass surgery. Patients were deemed to have significant impairment if they had a 20% decrease in test scores.

This study had three major findings

1) 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.
2) The incidence of cognitive impairment was greater than most doctors would have predicted. In this study, 42% of patients had at least a 20% drop in test scores after surgery.
3) The impairment was not temporary, as many doctors have claimed (or at least hoped). The decrease in cognitive capacity persisted for 5 years.

The mental impairment was not due to the patients' age (which averaged 61). The results from the Duke study were compared to results from a similar study among patients of the same age who did not have bypass surgery. The decline in mental capacity in those who had bypass surgery was 2 -3 times higher over five years than in patients who did not have surgery.

The authors could not say what, exactly, caused the impairment in mental capacity. The most common speculation is that the mental changes are due to the showering of the brain with tiny particles (microemboli) related to the use of the bypass pump (the heart/lung machine, that oxygenates and pumps the blood while the heart is stopped during surgery.)

If this is the case, then newer surgical techniques such as ?beating heart surgery? (in which the bypass pump is not used) should help to minimize the problem. The Duke study was completed prior to the use of such procedures.

But there are other possible causes for mental impairment, including the ?trauma? of surgery (any surgery) and general anesthesia in patients whose vascular disease is almost never limited to the heart, and the breaking loose of fatty deposits from the aorta when sewing the bypass vessel to the aorta.

 

[Lynlw]

This is about coronary artery bypass surgery, not all patents that used the bypass machine.So the stats would probably be different and relate alot of age/whatever was blocking their arteries to begin with ect

 

[boomersooner]

See I was thinking it would relate because it says that the cause is because of the heart and lung machine creating debris. So if you have OHS and go on the heart and lung machine wouldnt you run the same risk? I agree that age probably has alot to do with it as the average age of patients in this study was 61!

 

[Lynlw]

See I was thinking it would relate because it says that the cause is because of the heart and lung machine creating debris. So if you have OHS and go on the heart and lung machine wouldnt you run the same risk? I agree that age probably has alot to do with it as the average age of patients in this study was 61!

I BELIEVE alot of the debris is the breaking up of the plaque ect that causes the coronary artieries to need bypassed. So for surgeries that are on young people or people with clean arteries, the chances would probably be alot lower

 

[Cooker]

I actually got smarter. What I thought was pump-head I now believe was the residual effects of the drugs. After a while all was clear as a bell and if I had sustained drain bramage I think I would know it.

 

[Lynlw]

Well, they did have a control group of age-matched patients. One of my questions is, were the control subjects matched on other variables as well as age? The best control group would have been people who were similar in not just age, but also similar in their disease status (should be coronary artery disease at similar stage of severity to the CABG subjects), habits (e.g., smoking), and other variables that could make a difference in their brain functioning.

That's what I was thinking, I doubt the control group would really be "fair" in a case like this, since probably they only thing they have in common is age, not the problems that caused the person to need bypass surgery, OR they also would have had surgery.

 

[boomersooner]

I believe I found the article on the NEJM website but I do not have access to the full report.

 

[Bina]

I think that most of us suffer from the "regular" pump head experience; the post op stage of being in a fog, fuzzy, lacking in complete thoughts, etc. This can last for days, weeks, or even months....but I wouldn't go so far as to include a 5 year time frame.

 

[WayneGM]

I experienced the "regular" pumphead experience (as Bina described) in the first year but since then the episodes are nominal but not gone entirely (21 months ones out). However, I'd be shocked if I still experienced this 5 years out since with time it is disappearing. None of my docs ever mentioned it and I only learned of it on this site.

 

[Adrienne]

I've always been a bit of a "pumphead" so I can't tell the difference!! Seriously, though, I am two years post surgery, and I really don't notice a difference.

 

[ALCapshaw2]

I asked the surgeon who did my AVR about the "pumphead" issue. He told me that they used the BEST FILTERS at his hospital.

There was a discussion on this subject some time ago and someone posted that studies were underway to investigate the problem. Hopefully it is less of an issue now than it was before year 2000 (or so).

ONE recommendation was to lengthen the "warm-up" time (by 5? minutes) following surgery. My understanding is that gas bubbles were formed in the blood if it was warmed too rapidly and these could result in 'mini-strokes'.

'AL Capshaw'

 

[Marguerite53]

I asked the surgeon who did my AVR about the "pumphead" issue. He told me that they used the BEST FILTERS at his hospital.

There was a discussion on this subject some time ago and someone posted that studies were underway to investigate the problem. Hopefully it is less of an issue now than it was before year 2000 (or so).

ONE recommendation was to lengthen the "warm-up" time (by 5? minutes) following surgery. My understanding is that gas bubbles were formed in the blood if it was warmed too rapidly and these could result in 'mini-strokes'.

'AL Capshaw'

Yes. I'm sure Al is correct.

This is an old study. Thanks to this study, filters are in place to catch the debris. My surgeon assured me that changes had taken place. He had heard of the warming trend and he did it as a matter of course now. I had heard that they can charge you extra OR time for that warm-up, but that was not the case with me. I believe it is the anesthesiologist who must be vigilant with your body temp.

Please do not over analyze old studies. But please bring them up to your surgeon as I did so that you can get reassurances or look for a new surgeon.

Marguerite

 

[MikeHeim]

I, for one, am not willing to just dismiss the study. 2001 is not a very old study at all and I have certainly seen much older studies cited on this site and taken as gospel - especially those relating to tissue valve lifespan, valve repair success rate, rates of coumadin bleeding events, etc. One of the previous posts did hit on a very important point, that being that the study notes a 20% drop in test scores and not in cognotive ability. A very interesting detail to help get to the bottom of this would be to know of what form the test was. Did it have to do with true cognotive ability (like an IQ test), or did it have to do with reading comprehension and baseline knowledge (like SAT's)?

I personally believe that I have a more difficult time remembering things (especially names) than I did prior to my surgery. I also seem to have a more difficult time concentrating as well (my mind is always wandering). On the other hand, I don't believe I ever experienced the "fog" or "haze" that a lot of the other folks around here talk about - maybe I'm still in it. Are any of these things related to being on the pump? Who knows?

 

[hensylee]

ditto what Mike said. I have a horrid time with names. People I have known forever or met 5 minutes ago. And steady concentration.

 

[tobagotwo]

Al, the way I remember it, the reasoning for the slower warmup time was that the brain generates a very sudden demand for oxygen, if the critical temperature is reached too quickly. The system can't supply enough oxygen quickly enough, causing some possible damage from oxygen starvation.

I believe the microbubble issue was from a turbulence study done on the cusps of mechanical and tissue replacement valves, which some feared at the time would cause increasing brain damage over the years from these microbursts.

Some thoughts...

The largest population that receives bypass operations are in advanced years. Testing used to show that as we get older, our intelligence "lessens" because we are slower in our responses. Newer testing has considered that as you age the number of possible answers increases, and "they" now are starting to attribute much of the delay to having more data to process. Is this factored in?

Besides the age factor, many of those who receive bypass operations (valve replacements are only a portion) are in declining health for arterial blockages and a host of unrelated, but severe reasons. These other health issues can have an enormous effect on response to mental challenges, especially if there have been ministrokes or other brain events.

A third factor is prescriptions. Over half of all mental confusion in the elderly is thought to be caused unwittingly (sorry, it's just such an appropriate adverb) by drug interactions and inappropriate precriptions. That age population is highly represented here. These people have health issues that bring them to the doctor frequently, and wind up with more scrips because of it.

There are other monkey wrenches that can easily be thrown into these conclusions, too. But what I'm saying is that the study may be correct in its results without proving that the bypass had anything to do with it at all. The proof of causation is a much more of a guessing game than a certainty in such a wide-open study group, with so many age- and health-related variables present.

There are other studies out there that have shown that there can be some temporary damage (in some, not all) patients, and that it usually rights itself after about a year. At least one of those studies is referred to in the earlier archives of this site, and someone may wish to dig it out.

I think that...um, wait...I was talking about...what was this thread about, again..?

Best wishes,

 

[francie12]

Both of my parents had surgery in their elder years and both experienced a permanant decrease in their cognitive abilities post-op--but neither surgery involved a heart/lung machine. We attributed their mental effects to the anesthesia, and indeed were told that it is not uncommon for elderly patients to respond like this to anesthesia and medications. If the patients in this study were all over 61, then it may have nothing to do with pumphead.

 

[Gnusgal]

I have been on bypass two times, and have had surgery a total of 16 times. I do believe my <i>memory</i> has become worse over the years, but I do not believe my "cognitive ability" has changed.

I'm only 31 and frequently walk into rooms with a specific purpose, but by the time I get in the room I have completely forgotten what that purpose was. Many times my DH will talk about something we did or a conversation we had and I will have absolutely no recollection of the event, no matter how many details he gives me. Coworkers frequently tell me I'm "too young" to have the memory problems I have. I joke with them that I've been given too much anesthesia, and it's fried my brain.

However, I believe my IQ is still where it used to be and even completed my MLS degree with a perfect 4.0. I do not feel like it is more difficult to solve problems or learn new things. If that were to happen THAT would bother me big time. Yes, it's annoying to have little memory lapses, but I can handle that as long as I still have the ability to learn new things!

Is this because of the bypass? I don't think so. Personally, I think it's the drugs. When a person undergoes surgery as many times as I have, there's no way the brain will be completely unaffected.

 

[Marguerite53]

I, for one, am not willing to just dismiss the study. 2001 is not a very old study at all and I have certainly seen much older studies cited on this site and taken as gospel - especially those relating to tissue valve lifespan, valve repair success rate, rates of coumadin bleeding events, etc. One of the previous posts did hit on a very important point, that being that the study notes a 20% drop in test scores and not in cognotive ability. A very interesting detail to help get to the bottom of this would be to know of what form the test was. Did it have to do with true cognotive ability (like an IQ test), or did it have to do with reading comprehension and baseline knowledge (like SAT's)?

I personally believe that I have a more difficult time remembering things (especially names) than I did prior to my surgery. I also seem to have a more difficult time concentrating as well (my mind is always wandering). On the other hand, I don't believe I ever experienced the "fog" or "haze" that a lot of the other folks around here talk about - maybe I'm still in it. Are any of these things related to being on the pump? Who knows?

Mike, you make some good points. But, well, tissue valve lifespan is changing as we speak practically; ie, getting longer. So I would never take anything as gospel old or new on the matter of valve lifespan. (not to mention individual variables.....remember how many people here have had failures)

As far as memory lapses and cognitive ability....I can't know why it is I can't call up names sometimes....or descriptive words which are just on the tip of my tongue and my husband has to wait and wait for me to fish them out. Wanna know what I think? I think it's lack of motivation. I think we don't care as much. We've been on a journey that has taught us to value some different things about life and that many of us have changed priorities. So it may be difficult to focus on the minutia (is that spelled right?) ..... details ..... when we know for a fact, nothing ever comes out perfectly, and why should we care so much??

Along with the glow of extended lifespan, and it is a warm and grateful glow, I know I have a slightly tainted perspective of things now. I'm less patient. In many ways, I think my cognitive ability has improved.... no longer persuaded by some of the marketed notions of success, or cultural demands of getting it done yesterday. I at first thought it was just my turning 50 that did this, but I'm beginning to think it is this new lease on life.

My 2 cents.... At this very second, for the life of me, as I write, I do not remember which thread this one was!!! I was answering several, and we always get off on tangents. Aren't tangents wonderful??? Shouldn't we enjoy them as much as the reality sandwich of life??

Marguerite

 

[Bryan B]

What was the question again?

I was on the "pump" for 4 hours during my Ross Procedure. Actually my surgeon tried to repair my valve first, then took me off the pump to test it, then wasn't comfortable with the results knowing I wanted a long term solution, then back on the pump for the Ross. I don't recall having any significant problems after surgery. If anything I feel like I was sharper right after surgery than I am now. Is it too late to claim pumphead after nearly 4 years?