heart surgery has no lasting harm on the brain

[Phyllis]

Good News for Heart Bypass Surgery Patients
Updated 4/25/2005 10:28:25 PM

By Salynn Boyles


April 25, 2005 -- There is reassuring evidence that having surgery to help your heart does no lasting harm to your brain.

In the most comprehensive review to date, no support was found for a link between heart bypass surgery and long-term memory loss or other mental declines. The heart bypass surgery was associated with short-term memory loss, however.

"We believe most patients who experience cognitive decline [following heart bypass surgery], will return to their baseline by three months or sooner," says Johns Hopkins School of Medicine neuropsychologist Ola A. Selnes, PhD.

Declines Probably Due to Other Causes

Heart bypass surgery involves rerouting blood around clogged arteries to improve the supply of blood and oxygen to the heart.

Researchers from Duke University first raised concerns about the long-term impact of having the surgery on memory and mental function in a highly publicized study five years ago. The researchers reported that well over a third of patients still had measurable mental decline five years after having heart bypass surgery.

But it was not clear if the declines were caused by the heart bypass surgery, the heart disease that prompted the surgery, or by natural aging.

The new review, published in the May issue of Annals of Neurology, was conducted by Selnes and Johns Hopkins neurologist Guy M. McKhann, MD. The two have long studied the impact of heart bypass surgery on mental function.

They concluded that the research confirms the existence of mild memory and other thought problems lasting up to three months after surgery, possibly due to short-term disruption in blood flow to the brain or to the effects of anesthesia.

They found no evidence linking the heart bypass surgery to long-term mental impairment, however.

"There is no question that immediately after surgery people can have trouble, primarily with issues of memory," McKhann tells WebMD. "But our feeling is that any long-term declines are probably related to underlying vascular disease and not to surgery."

But McKhann says the question will probably not be answered for good until the results of several ongoing studies, including one that his research team is conducting, are reported in one or two years.

The studies are comparing long-term cognitive outcomes among heart bypass surgery patients, patients with heart disease treated without surgery, and a comparison group without heart disease. The idea is to determine if mental declines are caused by the surgery itself, by underlying heart disease, or by aging alone.

In the meantime, Delaware heart surgeon Timothy Gardner, MD, says the newly published review should reassure both prospective heart bypass surgery patients and their doctors. Gardner is medical director of the Center for Heart and Vascular Health at Wilmington's Christiana Care and is a spokesman for the American Heart Association.

"A lot of people in the field and outside of it have accepted the idea that heart surgery can cause permanent injury to the brain, so this can be seen as very reassuring," he tells WebMD. "Especially since the people who conducted this review are experts in the field."


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SOURCES: Selnes, O. Annals of Neurology, May 2005; vol 57: pp 615-621. Ola Selnes, PhD, division of cognitive neuroscience, Johns Hopkins University School of Medicine, Baltimore. Guy M. McKhann, MD, department of neurology, Johns Hopkins University School of Medicine, Baltimore. Timothy Gardner, MD, medical director, Center for Heart and Vascular Health, Christiana Care, Wilmington, Del.; spokesman, American Heart Association.

 

[McCln]

You are going to have a hand full of people disagreeing with this. I still have a problem, well, it was like this before. Occasionally forgetting something. I still believe the best treatment is to keep the brian busy during the early part of recovery, before you go bakc to work or whatever. Doing crossword or circle a word or fill it in puzzles. Reading is good also. Something to get the brain working. That's all I have on this issue. Have a great day.

 

[Barry]

Kind of surprised that in the third variables they consider (e.g. aging), they don't consider meds. Since surgery I've been on beta blockers and they produce somewhat clouded consciousness, lethargy, and depressed mood for me. Not my favorite drug.

FYI, thanks to St. Allodwick, I'll be seeing my doc next month to see about being put on a blocker that's less fat-soluable. Apparantly fat-soluable blockers are more likely to have CNS side-effects than water-soluable ones.

 

[tobagotwo]

You mean I gotta tell people I was born this way? Sheesh!

Regarding beta-blockers...

Yes, Barry, but while non-fat-soluble beta blockers (such as Atenolol, which I am on) do provide the same slower heartbeat and lower blood pressure, they are not associated with reduced cardiac risks - which the fat-soluble ones are. How can it do the same job, but not protect the heart the same way? I really don't know. It just does.

To complicate it a little more, one of those types (probably the fat-soluble one) has recently been cited as a possible cause of liver problems.

It ain't gettin' easier...

 

[ALCapshaw2]

Interesting, BUT it sounds like self-serving hand waving to cover up the evidence that MANY patients have had cognitive impairment following heart surgery, especially in earlier times.

How would 'they' know that raising the body temperature following resulted in LOWER cognitive impairment following surgery if there had NOT been evidence of impairment beforehand?

How would 'they' know that using 'BETTER FILTERS' resulted in lower incidence of cognitive impairment if there had not been evidence of impairment beforehand.

We are fortunate that these strides have been made but does that mean there is NO risk?

Notice that the article carefully avoids proclaiming that no cognitive effects have taken place BEFORE the study was conducted. I am glad that this issue is being studied and that measures to address cognitive effects have been taken.

The last paragraph in the article bothers me the most. If the "EXPERTS" say you couldn't have lost some of your memory or cognitive skills, I guess it must all "be in your head" if you believe you have. It will be interesting to see what the other studies reveal.

'AL Capshaw'

 

[Georgia]

My guess is that there's no subset of subjects such as valvers in this study. Because many of us are of an age where we shouldn't be seeing significant cognitive changes within 5 years of surgery; and many of us who've had ohs in our 40's and 50's don't have heart disease per se (heart vessels healthy, etc.). So we're outside of the parameters of the study? And many of us find lasting effects of ohs - so who can they blame the "cognitive changes" on in this group? Since it can't possibly be the surgery???? I would guess that this younger, healthier group might skew their results and surely the surgeons don't want to take responsibility for what is patently a long term side effect of the surgery.

Oh, I'm such a cynic.

And I thank God for the surgery every day and if I forget a word or two or drift off and need to reread a few pages occasionally, it's a fairly low price to pay for feeling good.