Posted by Osman M. Nassar on May 01, 2001 at 18:04:57:
In Reply to: Re: 2 years old today posted by Jack Drum on May 01, 2001 at 18:03:46:
The following article indicates a mental decline for patients using the heart-lung machines. Since the Maze operation uses this machine, it could have the same effect. Did you feel any difference, say, in your memory befor and after the MAZE?
Here is the article:
Bypasses Extend Life, But Take A Mental Toll
February 21, 2001
Cox News Service
There was good news and bad news from Duke University two weeks ago regarding heart bypass surgery.
The good news was that the operation, performed more than 600,000 times a year in the United States, has become safe enough to be used increasingly on older and older patients, saving their lives.
The bad news was that this same procedure, while giving life on the one hand, often caused mental decline in those who got the extra years.
And the older the patient, the more likely the negative impact. Duke studied 261 patients and found that 42 percent of them had some measurable mental deficit five years after the procedure was done.
The most likely culprit is the heart-lung machine, used to pump and oxygenate the body's blood while the surgeon operates on the stopped heart. Tiny blood clots probably go to the brain, causing the mental loss, Duke said. But lowered blood temperature while on the machine may also play a role.
These are facts, it turns out, that cardiac surgeons have known for years. But how informed were patients? And even if they knew, did they have alternatives?
Two cardiac specialists - one, chief of cardiothoracic surgery at the University of Miami/Jackson Medical Center - told me they didn't think patients had been sufficiently warned.
"Probably not," said Dr. Tomas Salerno, the UM surgeon. "Should they be told? Of course. Is there another option? Until recently, no. We accepted an evil we had to live with."
But there is an alternative, as Duke mentioned when it released its study: the beating heart operation, where, as it sounds, the surgeon operates on the beating heart, eliminating the heart-lung machine.
Salerno performs the beating heart surgery. "I used to use the pump. I made my career, 25 years of my life (with it.) I began to realize what (Duke) proposed and I looked at other people and asked, "Isn't (beating heart) a better way to do this operation?' I abandoned everything I did before, and the majority of cardiac surgeons have not."
Dr. Mark Newman, who was the lead researcher at Duke, told me that only 15 percent to 20 percent of bypass surgeries are performed using the so-called offpump or beating heart operation.
I decided to ask a cardiologist - at random - about the study results and whether patients were informed enough about the possibility of mental decline.
"It's probably underemphasized," said Dr. Robert Chait, who has offices in Atlantis and West Palm Beach, Fla. (He's not a surgeon, so he doesn't perform heart bypass operations.)
He supports use of the beating heart operation. "When they can be done, good. If you can avoid a pump, I think it's a good thing."
But is the beating heart considered experimental? "That's hogwash," Salerno said. "I do the same operation as the other surgeons. Do you think an institution like the University of Miami, with cardiologists who are very skeptical and loyal to their patients, would refer patients if results were not good?
"The risks are about the same for mortality. Shouldn't we try to find a different way?"
Copyright 2001 Cox News Service. All rights reserved.