On pump vs. off pump

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J

John M.

My cardiologist tells me I may soon need my aortic valve replaced, although he won't know for sure until I have a TEE for further diagnosis. Meanwhile, I do have some blockage in my LAD that has been stented and that may require bypass surgery. My cardiologist said if all he does is to deal with the bypass, he can work off-pump. However, if he in fact does decide it would be the right time to include the valve replacement during the grafting procedure, he would have to work on-pump.

Can those of you who have had experiences with each of these -- on-pump and off-pump -- share with me what I might expect in terms of post-op recovery. Is it accurate to assume that off-pump recovery is typically not as difficult or as long as on-pump recovery?

Your comments are most appreciated.

Thank you.

John M.
 
Hi John-

I am not going to go into this in very great detail because all of my husband's surgeries have been on-pump.

But I'd like to venture an observation. On-pump surgeries have traditionally caused "pump-headedness", forgetfulness which can be troublesome.

However, I have noticed that many of the most recent surgical patients have seemed to be sharp as a tack, even right after surgery. Their posts have been very clear. I'm kind of hoping that there have been some breakthroughs for this problem. I know many medical professionals were working hard on it. That would be wonderful.
 
RE:pUMPHEADS

RE:pUMPHEADS

Nancy, your observation is really interesting. As I've previously mentioned, I have a bit of aphasia resulting from chemotherapy I had 13 years ago. I've been quite surprised that I haven't been affected at all by being on the pump; the aphasia isn't the slightest bit worse and I've had NO memory issues (other than stuff I WANT to forget like pt/inr tests ;) ). I've been really pleased.

When I first read of the issue, I was surprised because I hadn't had the problem. So I waited until it "hit" and it didn't. I think you're probably right; that they know what they're doing and are managing brain circulation (or whatever) better.
 
Thanks

Thanks

That is encouraging news, especially for one sitting in the waiting room. The only thing I hope to forget is the experience in the ICU.
Chris
 
Time on the pump

Time on the pump

could make a difference, too. My daughter still says that my surgeon told she and Hubby that he only had me on it for 22 minutes....:) Now, I was foggy-headed for a few weeks..Like trying to talk on phone..but no memory loss.:D Bonnie
 
Chris

Chris

If you don't quit worrying about when you are in ICU....I am going to come up for your surgery and go in with your family..and turn up the "Good Stuff"..I.V.:p :p :p When your private ICU nurse is not looking.:D By the way, when are you going topost a picture of yourself?:p Bonnie
 
You'll have to talk to Bonnie about that not remembering the ICU - she's the gold standard. Unfortunately, I remember enough of that so I'm truly respectful of the process; and not enough to fixate on it. It's just something that happened and was not pleasant, but on a scale of 1 to 10 of tough medical stuff, I'd make it a 5, tops. And the most difficult parts were very short-lived.

Now that I'm 2 1/2 months out, I find this whole thing much less traumatizing than dealing with the cancer I had; although the procedures and meds are so much more rigorous and painful than what I had with breast cancer, I feel like I'm getting better. With cancer it was 3 not-very-big-deal surgeries, then 24 weeks of chemotherapy, then 6 weeks of radiation; then year after year of not knowing if it'd come back. I found that much more disturbing and emotionally and psychologically trying than one big (HUGE) surgery and recovery.

I think that when you're actually scheduled for surgery and it's all inevitable that part of one's brain seems to shut down and there's some deeply felt acceptance of what would have previously seemed inconceivable.

And I has spoken!!!
 
Georgia

Georgia

NOT making light of ICU..as you say..it's just something that happens..not pleasant.....It reminds me of childbirth(in the old days)...NOT pleasant but when they put that precious baby in your arms..all bad memories fade:D :D Bonnie
 
Oh boy oh boy Georgia...

Oh boy oh boy Georgia...

Are you ever right! I'll take a one shot open heart surgery anyday over ANY kind of cancer. I don't even care if it's a skin cancer -- cancer is serious stuff! I gotta big fear of the 'Big C.'

My younger sister had breast cancer in 1989 and seemed to whiz through it... I have a feeling if that had been my case, I would have been a nervous breakdown waiting to happen...:D

On the ICU issue....I just can't seem to remember that... Oh and yeah Chris -- where's that picture?
 
OK OK

OK OK

You guys are relentless--- I'll try to get a picture installed. Just don't blame me if all your computers break. Chris
 
from a pumphead

from a pumphead

:) I had aortic valve replacement 3/18/03, surgery lasted 4 hours and I remember most everything from waking up on the vent in ICU. So far, from what I have read online and observing a friend's recovery from same surgery last November, I think maybe the length of time on the pump and each individual's medical makeup determines their recovery. We are all different. My friend still has some memory problems according to her husband, but her stamina seems ok.

My ICU experience was a positive one, excluding being on the vent. It is something a person has to go through to get well.

Good thoughts to you!
 
I was "on the pump" for 10 hours during a 14 hour surgery. I can detect no problems relating to that at all. According to my surgeon, a lot of so-called pump-headedness these days has a lot more to do with the anesthesia and other drugs than the pump itself.

--John
 
pump

pump

I was on the pump for all four surgeries. I like John had very very long surgeries the third and fourth. 13 hours and 15 hours. I was pretty sick after the third so I don't know about that. The fourth though went very well and I really don't recall anything uneventful about it. As for ICU Chris, I wouldn't be afraid of that at all. You will have someone very very skilled watching you constantly. I was out of it most of the time. The first real memories I have for other then going in and out of conciesness was right before they moved me to a regular room. I am also with Janie on the Vr vs. Cancer thing. The C word scares the heck out of me too. If I had to pick between the two it would be heart surgery over and over again.
 
I have never before heard this term. I also probably will now never forget it- unless of course I end up with some of this pumpheadedness on top of my hardheadedness:) .

I honestly would like to know more. How common is it? I want everyone one to know how wonderfully helpful this site is to me. You are all incredible to share like you do.

Thanks.
 
On Pump

On Pump

John M.;
I was "on the pump". No problems.
Don
AVR; 4/02; MI; CCF; Cosgrove; Bovine
 
Hi BVDR

Hi BVDR

Your're not talking to an expert - I'm still sitting in the waiting room, but I think you could describe pumpheadedness as having difficulty concentrating, some temporary loss of memory, and I think I've heard the term fuzzy head. It could be that the pump doesn't provide quite enough oxygen or as said before, it could be the medication. We probably have a definitive expert somewhere in our ranks that can help us out. What about it guys ?
 
I posted this a while back and also recently on another forum, regarding the heart-lung machine and brain problems.

And Johnny Stephens also posted another slant on the investigation of the problem. Maybe he can resurrect his post from the past.
***********************

"Pumpheadedness" study---help on the horizon??
Doctors Test Post-Bypass Memory Drugs

Story Filed: Tuesday, November 05, 2002 7:10 AM EST

WASHINGTON (AP) -- Call it brain fog, that loss of memory and thinking ability that strikes tens of thousands of patients after open-heart surgery, and sometimes other big operations, every year.

Now doctors are studying if giving patients certain drugs just before a heart bypass could prevent this mental decline by essentially protecting the patients' brain cells from the rigors of surgery.

The clinical trials mark a turning point: For decades, doctors didn't know what to make of patient complaints that in getting their hearts fixed, something hurt their brains.

Today, few doubt it's a real problem that affects not just heart patients but those undergoing other major surgeries, too, such as hip or knee replacements. Often, patients recover. But one study found 42 percent of heart-bypass patients suffer significant drops in mental sharpness that can last not just months but years. Other research suggests 10 percent of hip-replacement patients suffer similar mental decline.

In some ways this ``postoperative cognitive dysfunction'' is a byproduct of the modern operating room. As surgery -- particularly the half-million heart bypasses performed every year -- has become increasingly successful, aftershocks such as a muddled brain draw more concern.

``It's a big quality of life issue,'' says Dr. James Cottrell, president of the American Society of Anesthesiologists.

No one knows yet what's to blame. It may be that only certain people are at high risk, such as those whose brain blood vessels are starting to clog and something about surgery speeds up the disease.

For now, suspects range from the heart-lung machine that circulates bypass patients' blood -- it can dislodge tiny bits of fat, blood clots or air bubbles that flow to the brain -- to the inflammation and post-surgery fever that are a risk after any major operation.

Surgery's stresses spark inflammation and other reactions that ``in some ways is the body's way of healing itself,'' explains Dr. Mark Newman, anesthesiology chairman at Duke University and a leading expert on post-surgery mental decline. ``But the question is if it goes beyond a certain level, do you end up with problems?''

That's where much of the prevention research centers: If surgery even temporarily blocks oxygen in part of the brain or sparks severe inflammation, the body reacts with a chemical cascade that injures or kills brain cells.

Newman and other scientists are studying if injecting patients with one of three different medications before a bypass could block that chain reaction and spare brain cells:

--Two small studies suggest lidocaine, normally used for irregular heartbeat, can prevent bypass patients' brain fog. Duke now is testing 250 bypass patients, half given lidocaine and half not, to see who has better brain function a year after surgery. Newman says lidocaine might work by blocking a pathway that lets toxic doses of calcium flood into oxygen-deprived brain cells.

--Certain levels of magnesium seem to block that toxicity, too, as well as lessen cell damage from inflammation. So, using federal money, Duke is enrolling 400 bypass patients into a study to see if magnesium might block brain fog.

--Initial testing of an experimental drug called pexelizumab, thought to block an inflammation-causing immune system protein, showed bypass patients who received the drug had slightly less mental decline. Duke and several other hospitals are participating in a 3,000-patient study of pexelizumab, sponsored by the drug makers Alexion Pharmaceuticals and Procter & Gamble.

Some companies also are testing if filters put onto heart-lung machines can help by keeping debris from flowing to the brain.

Until those studies are done, Newman advises patients worried about coming surgery to ask their anesthesiologists about one step believed to lower brain risk -- rewarming their cooled-down bodies more slowly than usual after the operation is done.

The key is intense temperature monitoring that tells when the brain, which warms faster than other organs, reaches 98.6 degrees, Newman explains. At that point, doctors should stop warming and let other organs gradually reach normal temperature on their own.



EDITOR'S NOTE -- Lauran Neergaard covers health and medical issues for The Associated Press in Washington.



Copyright © 2002 Associated Press Information Services, all rights reserved."
 
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