Probability of either a-fib or permanent memory issues post-surgery

[Freebird]

Hello,
I'm one of those who are in the 'waiting room' around here. I got my surprise diagnosis of bicuspid av about a year ago. I'm 58, asymptomatic, with a 4.2 aneurysm and in severe stenosis. I've met with two cardiologists and two surgeons and our plan of action is to wait for symptoms or for a worsening echo. I get an echo every 6 months. I've had 3 in the past year since diagnosis.

I've more or less wrapped my head around the surgery but I continue to read about two issues that concern me:

1. It seems like many have to get pacemakers after this surgery. I believe I asked my cardiologist about this and she said it most often happens with folks with high blood pressure? I should note I have normal to low bp and normal cholesterol and a 0 calcium score. Is the need for a pacemaker after surgery common for someone like myself?

2. I read about folks having pump head or general memory issues after surgery. Is this common? Is it age related? Is it permanent or does it correct itself over time? Is it due to the surgery being so long? I've heard it's an 8 hour surgery, correct?

So many questions. I'm grateful for any input.

 

[dick0236]

I don't think that pacemakers typically follow this surgery. I've known many over the years that have had OHS but have not needed a pacemaker......me included. I've also known many who have had pacemakers with no surgery.

I never heard about "pumphead" until I joined this forum. So far as I know, I never suffered from this. FWIW, I studied for, and received, a Masters Degree in Finance AFTER surgery and at 84 I still have reasonably good memory.......2+2=4, right?.........or is it 5?, hmm

 

[pellicle]

Hi

first the facts:

• without the surgery you'll die much earlier and the last few years will not be comfortable.
• the surgery is one of (if not the) most successful surgeries in the medial surgical repertoire
• don't wrap your head around it, because that brings nothing but anxiety. There is nothing to wrap around, nothing to bargain out of it, nothing to be attempting to influence except where and who to do it.

so, with that as the basis

1. It seems like many have to get pacemakers after this surgery.

many ... yes, but many relatively no. There are millions of these heart surgeries done, something like 3% require a pacemaker (and no I didn't just pull that out of a convenient orifice behind me).

https://www.ncbi.nlm.nih.gov/pubmed/29577930

A total of 2,600 consecutive patients undergoing surgical aortic valve replacement over the past 15 years were reviewed using The Society of Thoracic Surgeons (STS) institutional database and Social Security death records. Patients were stratified by placement of a PPM within 30 days of surgery. The impact of PPM placement on long-term survival was assessed by Kaplan-Meier analysis and risk-adjusted survival by Cox proportional hazards modelling....A total of 72 patients (2.7%) required PPM placement postoperatively.​

​

I believe I asked my cardiologist about this and she said it most often happens with folks with high blood pressure?

google it yourself, don't rely on stuff you're told without citations.

2. I read about folks having pump head or general memory issues after surgery. Is this common? Is it age related? Is it permanent or does it correct itself over time? Is it due to the surgery being so long? I've heard it's an 8 hour surgery, correct?

Tons written here about that, let me give you a hint on searching. Do not go to any site festered with ads, only read peer reviewed materials and the devil is always in the detail (meaning researchers are often pushed to provide an angle).

MY take on pump head (and I had it) is this: almost any brain injury is treatable. Like with all therapy YOU have to do the work, the therapist simply guides. You have to want to get better ... its summarised nicely by this joke:

How many Buddhists does it take to change a light bulb?​

One, but the light bulb has to want to change.​

​

You can and will find people who dropped their bundle and went all "I give up" after surgery; they often have a 5hit run. You'll find people who are fighters and now matter what the hell happens keep putting one foot in front of the other, make goals and do their best to achieve them.

Ultimately we're all "dead men" however as was so eloquently phrased in Shawshank Redemption "Get busy living, or get busy dying"



myself I'm a fighter and knowing what I fought for and how hard it was I come here to encourage others to fight, and to encourage others that its not as bad as "the worst you read about" and to help fellow valvers who are on ACT to manage that best for the best outcomes.

Focusing on the worst outcomes will not help you, and it doesn't matter how long the surgery is because you're out to it. Mine was 13 hours because it was a complicated redo of a redo ... I'm a data-analyst and software developer, and for months I couldn't add up or make sense of maths ... I got better.

I advise you to read my post here: https://www.valvereplacement.org/threads/just-plain-scared.887362/#post-893956

Best Wishes

 

[Freebird]

Hi

first the facts:

• without the surgery you'll die much earlier and the last few years will not be comfortable.
• the surgery is one of (if not the) most successful surgeries in the medial surgical repertoire
• don't wrap your head around it, because that brings nothing but anxiety. There is nothing to wrap around, nothing to bargain out of it, nothing to be attempting to influence except where and who to do it.

so, with that as the basis



many ... yes, but many relatively no. There are millions of these heart surgeries done, something like 3% require a pacemaker (and no I didn't just pull that out of a convenient orifice behind me).

https://www.ncbi.nlm.nih.gov/pubmed/29577930

A total of 2,600 consecutive patients undergoing surgical aortic valve replacement over the past 15 years were reviewed using The Society of Thoracic Surgeons (STS) institutional database and Social Security death records. Patients were stratified by placement of a PPM within 30 days of surgery. The impact of PPM placement on long-term survival was assessed by Kaplan-Meier analysis and risk-adjusted survival by Cox proportional hazards modelling....A total of 72 patients (2.7%) required PPM placement postoperatively.​

​

google it yourself, don't rely on stuff you're told without citations.




Tons written here about that, let me give you a hint on searching. Do not go to any site festered with ads, only read peer reviewed materials and the devil is always in the detail (meaning researchers are often pushed to provide an angle).

MY take on pump head (and I had it) is this: almost any brain injury is treatable. Like with all therapy YOU have to do the work, the therapist simply guides. You have to want to get better ... its summarised nicely by this joke:

How many Buddhists does it take to change a light bulb?​

One, but the light bulb has to want to change.​

​

You can and will find people who dropped their bundle and went all "I give up" after surgery; they often have a 5hit run. You'll find people who are fighters and now matter what the hell happens keep putting one foot in front of the other, make goals and do their best to achieve them.

Ultimately we're all "dead men" however as was so eloquently phrased in Shawshank Redemption "Get busy living, or get busy dying"



myself I'm a fighter and knowing what I fought for and how hard it was I come here to encourage others to fight, and to encourage others that its not as bad as "the worst you read about" and to help fellow valvers who are on ACT to manage that best for the best outcomes.

Focusing on the worst outcomes will not help you, and it doesn't matter how long the surgery is because you're out to it. Mine was 13 hours because it was a complicated redo of a redo ... I'm a data-analyst and software developer, and for months I couldn't add up or make sense of maths ... I got better.

I advise you to read my post here: https://www.valvereplacement.org/threads/just-plain-scared.887362/#post-893956

Best Wishes

Pellicle, thank you for your thoughtful, and hopeful response. I needed that. So this tells me I have a 97% chance of not needing a pacemaker. I'll take those odds.

Re pump head. So it seems to me you're saying it is reversible, with effort. I am thinking that things like continuing to learn French and Piano would be good uses of my time post-surgery. Is this the sort of thing you're referring to or is there some sort of more formalized method of recovery?

 

[Freebird]

Hi

first the facts:

• without the surgery you'll die much earlier and the last few years will not be comfortable.
• the surgery is one of (if not the) most successful surgeries in the medial surgical repertoire
• don't wrap your head around it, because that brings nothing but anxiety. There is nothing to wrap around, nothing to bargain out of it, nothing to be attempting to influence except where and who to do it.

so, with that as the basis



many ... yes, but many relatively no. There are millions of these heart surgeries done, something like 3% require a pacemaker (and no I didn't just pull that out of a convenient orifice behind me).

https://www.ncbi.nlm.nih.gov/pubmed/29577930

A total of 2,600 consecutive patients undergoing surgical aortic valve replacement over the past 15 years were reviewed using The Society of Thoracic Surgeons (STS) institutional database and Social Security death records. Patients were stratified by placement of a PPM within 30 days of surgery. The impact of PPM placement on long-term survival was assessed by Kaplan-Meier analysis and risk-adjusted survival by Cox proportional hazards modelling....A total of 72 patients (2.7%) required PPM placement postoperatively.​

​

google it yourself, don't rely on stuff you're told without citations.




Tons written here about that, let me give you a hint on searching. Do not go to any site festered with ads, only read peer reviewed materials and the devil is always in the detail (meaning researchers are often pushed to provide an angle).

MY take on pump head (and I had it) is this: almost any brain injury is treatable. Like with all therapy YOU have to do the work, the therapist simply guides. You have to want to get better ... its summarised nicely by this joke:

How many Buddhists does it take to change a light bulb?​

One, but the light bulb has to want to change.​

​

You can and will find people who dropped their bundle and went all "I give up" after surgery; they often have a 5hit run. You'll find people who are fighters and now matter what the hell happens keep putting one foot in front of the other, make goals and do their best to achieve them.

Ultimately we're all "dead men" however as was so eloquently phrased in Shawshank Redemption "Get busy living, or get busy dying"



myself I'm a fighter and knowing what I fought for and how hard it was I come here to encourage others to fight, and to encourage others that its not as bad as "the worst you read about" and to help fellow valvers who are on ACT to manage that best for the best outcomes.

Focusing on the worst outcomes will not help you, and it doesn't matter how long the surgery is because you're out to it. Mine was 13 hours because it was a complicated redo of a redo ... I'm a data-analyst and software developer, and for months I couldn't add up or make sense of maths ... I got better.

I advise you to read my post here: https://www.valvereplacement.org/threads/just-plain-scared.887362/#post-893956

Best Wishes

Also, I appreciate your reference to Marcus Aurelius as it reminds me of something the Buddhists teach about suffering. Buddhists say that any time we suffer misfortune, two arrows fly our way. The first arrow is the actual bad event, which can, indeed, cause pain. The second arrow is the suffering. That's actually optional. The second arrow represents our reaction to the bad event.

I meditate daily and benefit from it greatly. Pellicle again, thank you for your helpful words.

 

[pellicle]

So it seems to me you're saying it is reversible, with effort. I am thinking that things like continuing to learn French and Piano would be good uses of my time post-surgery.

pretty much those sorts of things (unless you have something very serious like a car accident). The brain is surprisingly plastic in re-shaping itself and its neural path ways around obstacles.

I'm sure you'll do fine

 

[pellicle]

Also, I appreciate your reference to Marcus Aurelius as it reminds me of something the Buddhists teach about suffering.

its interesting, I studied the Stoics first, then Buddhism, but came back to Stoicism because its closer to my society views (being raised in the West)).

Sadly I've seen quite a few people "drop their bundle" when confronted with an uphill climb in recovery. I've made a point of reaching out to them (some were actual family of my personal friends) but somehow they seemed to give up. I was saddened by that.

Don't hesitate to shoot any questions as they arise, there are many good folk here and offer a diversity of views, indeed that's the strength of the place.

Best Wishes

 

[Agian]

2+2=4, right?.........or is it 5?, hmm

'4' is the correct answer.

 

[pellicle]

..2+2=4, right?.........or is it 5?,

I understand you've been away from it for a while, its 22

 

[Paleowoman]

Hi @Freebird - I had aortic valve replacement for my bicuspid aortic valve when I was 60. I never needed a pacemaker and I've never had any memory problems !

The only 'side effect' I've had from the surgery is the development of migraine aura without headache. That seems to be something quite a few of us on this forum developed post cardiac surgery. Mine started the day after surgery - I get flickering patterns of light which start in centre of my vision and move outwards, lasts about 20 minutes, and sometimes double vision. But never any headache.

My surgery lasted about two hours but I only had aortic valve replacement, I didn't have an aneurysm. I was asymptomatic prior to surgery.

 

[Freebird]

Hi @Freebird - I had aortic valve replacement for my bicuspid aortic valve when I was 60. I never needed a pacemaker and I've never had any memory problems !

The only 'side effect' I've had from the surgery is the development of migraine aura without headache. That seems to be something quite a few of us on this forum developed post cardiac surgery. Mine started the day after surgery - I get flickering patterns of light which start in centre of my vision and move outwards, lasts about 20 minutes, and sometimes double vision. But never any headache.

My surgery lasted about two hours but I only had aortic valve replacement, I didn't have an aneurysm. I was asymptomatic prior to surgery.

Wow, just two hours? I wonder where I got the idea the whole thing would be 8 hours. If anyone else out there is reading this and got valve replacement + aneurysm repair, I'd love to hear estimates of surgery time.

 

[SiestaKeyJimmy]

Hi Freebird,

I had Open Heart surgery with a Quad By-pass 3 years ago, (at 76). The overall experience was much less painful and stressful than I was worried it would be.

The day that I was released, we were given an instruction sheet and 6-7 prescriptions. Once home I remember struggling to understand exactly which pill I should take, and when. For about 2-3 days I studied the instructions and still felt confused. Meanwhile my wife helped out and she couldn’t understand why the simple instructions were so complicated for me to understand.

Another funny thing was my bed; it felt somehow different to me, like I was laying in a river-bed (my bed is old and lower in the middle, but I had never really noticed anything weird about my bed before). Also food had little taste to me and I didn’t enjoy food that much.

(Importantly, during those first few days, I felt weak but GREAT to have it over with, and to be feeling relatively pain free, and HAPPY. I only took a pain pill at night to help sleep, and still have most of my pain pills.)

In a week or so, I had the pill schedule all figured out, and in a few more days, the bed was no longer weird. I was driving again normally in less than 2 weeks. Also food started to taste great again.

Looking back on it now, I realize my brain was kind of foggy, slow, and maybe slightly weird during those initial days, but of course I really didn't realize while it was happening, only later, thinking back. So I’d say whatever the effects of the lengthy surgery are relative to your brain, they are minor and completely go away before you even notice them.

During recovery in the hospital, I had a few episodes of A-fib, (which they treated with meds). I now sometimes can get some A-fib like “palpitations", (if I drink vodka excessively), my Cardiologist says stop drinking so much! (I have not required a pacemaker, though my Ex-wife, who has never had any heart surgery, recently had to get one).

 

[Freebird]

Hi Freebird,

I had Open Heart surgery with a Quad By-pass 3 years ago, (at 76). The overall experience was much less painful and stressful than I was worried it would be.

The day that I was released, we were given an instruction sheet and 6-7 prescriptions. Once home I remember struggling to understand exactly which pill I should take, and when. For about 2-3 days I studied the instructions and still felt confused. Meanwhile my wife helped out and she couldn’t understand why the simple instructions were so complicated for me to understand.

Another funny thing was my bed; it felt somehow different to me, like I was laying in a river-bed (my bed is old and lower in the middle, but I had never really noticed anything weird about my bed before). Also food had little taste to me and I didn’t enjoy food that much.

(Importantly, during those first few days, I felt weak but GREAT to have it over with, and to be feeling relatively pain free, and HAPPY. I only took a pain pill at night to help sleep, and still have most of my pain pills.)

In a week or so, I had the pill schedule all figured out, and in a few more days, the bed was no longer weird. I was driving again normally in less than 2 weeks. Also food started to taste great again.

Looking back on it now, I realize my brain was kind of foggy, slow, and maybe slightly weird during those initial days, but of course I really didn't realize while it was happening, only later, thinking back. So I’d say whatever the effects of the lengthy surgery are relative to your brain, they are minor and completely go away before you even notice them.

During recovery in the hospital, I had a few episodes of A-fib, (which they treated with meds). I now sometimes can get some A-fib like “palpitations", (if I drink vodka excessively), my Cardiologist says stop drinking so much! (I have not required a pacemaker, though my Ex-wife, who has never had any heart surgery, recently had to get one).

Thanks for the clear description of your brain fog. If that's what I'm in for I'll be fine.

 

[pellicle]

Thanks for the clear description of your brain fog. If that's what I'm in for I'll be fine.

I think its perhaps a worst case ... mine wasn't that bad. I understand its also age related (as well as duration on the pupmp). I was 48 on my third one and that was my only experience of it. I was 28 on my second (December ) and was back at Uni doing my Bachelor of Info Tech by Feb attending classes, doing stuff like how a parser engine works, object oriented programming and stuff like that. I had no observation of clouded cognition then.

So while "its a thing" its "not a certainty". Here's hoping you miss out on the experience.

 

[LoveMyBraveHeart]

Wow, just two hours? I wonder where I got the idea the whole thing would be 8 hours. If anyone else out there is reading this and got valve replacement + aneurysm repair, I'd love to hear estimates of surgery time.

Hi Freebird!

I am the fiance of a OHS x3 patient. His first surgery was an aortic valve repair and aneurysm repair. The surgery was about 3.5-4 hours, but there were complications with the repair of the valve part, so they ended up replacing it. That added some time to the surgery. Mathias was goofy coming out of anesthesia, but no pump head after that I could notice!

Round 2 was 9ish months after the first (severe paravalvular leak), it lasted about 5.5 hours, only included a valve re-replacement. The surgeons do warn you that each surgery is longer than the last because of wading through scar tissue during opening. Hard to say if he had pump head after that one, as we were in emergency OHS again for pericardial tamponade only 6 days after the 2nd surgery. That one was only about an hour long as they just had to evacuate the contents of his pericardium, but I will say he has pump head from this.

We are 4 months out from the last surgery, and he is much better than he was 2 months ago pump head wise, but his short term memory is tough for him sometimes. He also had trouble with remembering the name of common objects, but that was sooner after surgery than now. For example he would be staring at, say, a banana, and try his darndest to come up with the name of it and have to ask me for a reminder. It sounds scarier than it is, really. He would be blank for about 5 seconds, then remember or I would remind him. I would say daily brain exercises help immensely. Word games like cross words or word searches helped, as did cards and dice games, that require strategy or math helped a lot too and didnt feel like retraining your brain--we were just having romantic nights in with a glass of wine and a deck of cards. I would say at this point, his short term memory maybe lapses once a week, and even that could be an exaggeration. Nothing scary or dangerous, he will just ask me twice what is for dinner instead of once

Honestly, this was all so scary and overwhelming for us at first, but we have learned to just take each day as it comes. There will be good days and bad days and always hurdles to jump, but it gets easier and we are so fortunate to have this forum to fall back to when we have questions.

Best of luck to you,
Jill

 

[vitdoc]

Pacemakers after aortic valve surgery are usually needed due to what is known as 3rd degree heart block. The pathway for the signal from the atrium where it is generated can be interrupted by scarring around the surgical site. The pacer is used as a bridge where the heart's normal pacing signal in the atrium is sensed by a lead and then transmitted by the pacer to the ventricle. I had three surgeries. After the first no deficit after the second a partial deficit not requiring a pacer. After the third valve and aorta I needed a pacer. 13 years later still functioning fine.
Neurological issues after surgery are a bit different from straight bypass on a valve to the more radical cooling of the brain with acending aneurysm surgery. Here you are essentially brain dead until you are warmed up. The duration of the cooling has been associated with neurological deficits. So for aneurysm surgery one should go to an experienced center that does a lot to minimize the cooling time.

 

[pellicle]

Here you are essentially brain dead until you are warmed up.

errr ... are you suggesting that brain activity ceases?

 

[Freebird]

Pacemakers after aortic valve surgery are usually needed due to what is known as 3rd degree heart block. The pathway for the signal from the atrium where it is generated can be interrupted by scarring around the surgical site. The pacer is used as a bridge where the heart's normal pacing signal in the atrium is sensed by a lead and then transmitted by the pacer to the ventricle. I had three surgeries. After the first no deficit after the second a partial deficit not requiring a pacer. After the third valve and aorta I needed a pacer. 13 years later still functioning fine.
Neurological issues after surgery are a bit different from straight bypass on a valve to the more radical cooling of the brain with acending aneurysm surgery. Here you are essentially brain dead until you are warmed up. The duration of the cooling has been associated with neurological deficits. So for aneurysm surgery one should go to an experienced center that does a lot to minimize the cooling time.

Well, that cooling of the brain bit is quite sobering. I have chosen a hospital that is highly rated for outcomes for valve replacement according to surgeonratings.org as is my surgeon. I suppose it all beats the alternative.

 

[Protimenow]

'4' is the correct answer.

Not to get overly political - at the recent House Impeachment hearings, there was a lot of 2 + 2 = 4 discussion -- events and facts added up to impeachable offense. Most of the comments confirmed that the events referred to in the 2 + 2 = 4 DID add up.

There were others in the group, on in certain media outlets, who couldn't quite see an answer to the clear equation.

---

You've no doubt seen this in Australian media (and, most likely, worldwide).

As for pumphead - in many cases the person with the problem may not notice it - or know how to work back from it. And I'm not convinced that the brain can completely bounce back from some situations.

 

[vitdoc]

Yes brain activity ceases. An EEG is hooked to your head and your brain in cooled to about 60 F.
The EEG flattens out. The problem is when hooking up the ascending aorta the carotid arteries temporarily are not perfused. Hence the need to preserve neurological function. When I had my surgery I was down for about 30 minutes which is considered good. Over one hour of downtime starts to increase the risk of decreased cerebral function. I have not looked at any recent literature on this but that was the case 13 years ago and I don't think things have changed too much since. With normal valve surgery the carotids are perfused as is the rest of the body so no need to shut down the brain. Two articles about cerebral protection choices with aortic arch surgery.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233307/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853843/