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

[pellicle]

Yes brain activity ceases. An EEG is hooked to your head and your brain in cooled to about 60 F.
The EEG flattens out.

interesting thanks

 

[Astro]

The risk of requiring a pacemaker is fairly small. There are some super physically active members on this forum who have a pacemaker. Having a pacemaker doesn’t stop them and won’t stop you if you were unlucky enough to need one. (TAVI has a higher risk of pacemaker than open heart)

Memory loss (cognitive decline) is unlikely in people who have no pre-existing memory decline, are not really old, are active and otherwise well. When cognitive decline occurs, it is generally temporary.

Do you have any other concerns that we could discuss with you?

Best wishes

 

[Freebird]

The risk of requiring a pacemaker is fairly small. There are some super physically active members on this forum who have a pacemaker. Having a pacemaker doesn’t stop them and won’t stop you if you were unlucky enough to need one. (TAVI has a higher risk of pacemaker than open heart)

Memory loss (cognitive decline) is unlikely in people who have no pre-existing memory decline, are not really old, are active and otherwise well. When cognitive decline occurs, it is generally temporary.

Do you have any other concerns that we could discuss with you?

Best wishes

Thanks for your input. I guess the earlier comments about the surgical process needed to repair my aneurysm as it relates to my brain kind of threw me for a loop. Now I wonder if others who've had both, valve replacement and aneurysm repair might chime in re memory or cognitive issues post surgery. Still working on remaining positive!

 

[pellicle]

.... Now I wonder if others who've had both, valve replacement and aneurysm repair might chime in re memory or cognitive issues post surgery.

Not sure if it was cleat, but I had a complex aneurysm repair, complicated by 2 prior surgeries worth of scar tissue and a bovine anatomy arch.

Being positive is the only way to be

 

[Freebird]

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

Jill, as this thread continues, I've gone back and reread some entries, including yours. Based on the newer information about valve replacement + aneurysm repair as it relates to brain issues, I shall take your story as very positive. The first surgery yielded no memory issues. Thank you for sharing.

 

[Freebird]

Not sure if it was cleat, but I had a complex aneurysm repair, complicated by 2 prior surgeries worth of scar tissue and a bovine anatomy arch.

Being positive is the only way to be

Thanks for clarifying your experience. So that means you were technically also braindead (per previous post) and came out with recoverable brain issues as well, correct?

 

[Agian]

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.

There has been some debate, but most people here accept the answer is '4'. I can't understand why Americans are being polarised over something so trivial. I suggest people invest in calculators and draw their own conclusions, rather than relying on the media. I can put my hand on my heart and declare 2+2 equals 4. This holds true for me, but I accept others may not share this view.

I have done some of my best work whilst brain dead. Whenever I have a difficult task ahead of me, I stick my head in the freezer for a couple of hours. This allows me to clear my thoughts.

 

[tom in MO]

Before surgery, at your age, I wasn't told about pump head syndrome by my surgeon or cardiologist. I learned about it here. What I learned is that some have it and some don't. I specifically didn't ask about it because you've got to have the surgery, no use worrying about something you cannot control. There's nothing you can do now that will affect your possibility of any problems afterwards.

Same with the pacemaker. Most people don't get one and if you do it's not a big deal, many have them.

Turned out I got some pump head syndrome. The biggest effects were I became more empathetic, minor short term memory loss and the inability to calculate tips (i.e. do math in my head.) I would never be moved to tears by movies, weddings and funerals. After surgery I did. Some would call this an improvement since I am more than slightly "cold" It did effect my job because I cared too much when others f-ed up or the system was grinding things up. Now I'm not as emotive as after surgery, I can still get close to crying at a funeral or a sad movie, but can control it. This won't effect your job since per your info you are retired.

The short term memory and ability to do math in my head both came back with time, except for my ability to remember names. It got better but I wasn't good at that before surgery, but I am still worse afterwards. I write down names at meetings in order of sitting and my wife introduces herself first in case I forgot someone's name.

It took me about 6-12 months to be able to calculate tips in my head again.

I've had 5 surgeries and the valve replacement surgery effected me the most. I believe that the surgery screws with your subconscious that entity that nobody knows very much about since it's your SUB-mind. They pump you up with some serious psychoactive drugs (e.g. fentanyl.) Your animal brain knows your heart and lungs were stopped and you are/were dead. I couldn't sleep for 24-36 hours after surgery and usually I sleep like a rock after surgery. My toenails and fingernails stop growing to save energy. Your whole body goes WHAT THE F***. This effects different people in different ways, but we all come through to LIFE. You'll be fine. I am.

I think those who say it effects the elderly more are prejudiced against old people. My mother-in-law didn't have any similar problems and she had 30 years on me when she had her valve replacement at 85. Most of the people who have this surgery are elderly so its easy (and cheaper) to blame any cognitive problems on their age, not the surgery. My cardiologist knows about pump head syndrome, but not my GP. I now go to a neurologist and she is aware of it but it has nothing to do with the reason I get to see her every 6-months. My problem is old age, which is a blessing not a disease...

 

[pellicle]

... So that means you were technically also braindead

Some may argue still

 

[Paleowoman]

Your animal brain knows your heart and lungs were stopped and you are/were dead.

Yes, yes, yes - I was told similar by the senior nurse on the cardiac ward the evening before surgery - though he didn't say "animal brain" just "brain". Our brains must go into panic mode during surgery because we have been killed during surgery but knowing this 'intellectually' beforehand makes no difference. All the major stress hormones go into action too because all the brain knows is that you are being/have been killed and that is an emergency, the worst emergency the brain faces. And you can't fight or run away because you have been paralysed so the 'fight and flight' hormones go into overdrive too.

Those of us who have had heart surgery have literally faced our mortality which has psychological effects too. I remember some years before surgery reading a description of someone who'd had heart surgery who kept dreaming that she was being held down by murderers and stabbed - possibly a type of post traumatic stress ? PTSD is something that some people get following heart surgery, not surprising really.

 

[pellicle]

Cerebral Perfusion in Aortic Arch Surgery Cerebral Protection in Aortic Arch Surgery

these two readings led me to examine this subject more. Quite interesting that there was always a base metabolic load from neural activity as they chilled.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5140096/

The following from this is interesting:

Results

The study included 71 patients. Before CA, 47 patients (66%) demonstrated a continuous EEG pattern, with or without periodic complexes, and 24 (34%) had a burst suppression EEG pattern. Immediately after CA, abrupt loss of electrocerebral activity occurred in 32 patients (45%), suggestive of cerebral ischemia. Establishment of unilateral SACP rapidly restored electrocerebral activity in all but 2 patients. One patient had persistent loss of left-sided activity, which resolved after transition to bilateral SACP. Another patient had persistent global loss of activity and was placed back on cardiopulmonary bypass for further cooling before reinitiation of CA. No significant differences in characteristics or outcomes were assessed between patients with and without loss of EEG activity.​

Conclusions

Nearly half of patients undergoing hemiarch replacement with MHCA/SACP experience abrupt loss of electrocerebral activity after CA is initiated. Although unilateral SACP usually restores prearrest electrocerebral activity, intraoperative EEG may be particularly valuable for the identification of patients with persistent cerebral ischemia even after SACP.​

​

so (to apparently split hairs), I don't think one is 'brain dead' or that the goal of the technique is to cease brain activity, merely suppress it and the "fine line" is indeed fine. and that going "over that line" is not without consequences

Worth examining is this term mentioned above (underline mine)
https://en.wikipedia.org/wiki/Brain_ischemia

 

[tom in MO]

Yes, yes, yes - I was told similar by the senior nurse on the cardiac ward the evening before surgery - though he didn't say "animal brain" just "brain". Our brains must go into panic mode during surgery because we have been killed during surgery but knowing this 'intellectually' beforehand makes no difference. All the major stress hormones go into action too because all the brain knows is that you are being/have been killed and that is an emergency, the worst emergency the brain faces. And you can't fight or run away because you have been paralysed so the 'fight and flight' hormones go into overdrive too.

Those of us who have had heart surgery have literally faced our mortality which has psychological effects too. I remember some years before surgery reading a description of someone who'd had heart surgery who kept dreaming that she was being held down by murderers and stabbed - possibly a type of post traumatic stress ? PTSD is something that some people get following heart surgery, not surprising really.

Thanks for the information. I came to my belief by logic and conjecture. Nice to know I'm not the only one who thinks this. What really made me think about how my unconscious mind works is how it stopped my nails from growing to conserve energy. My conscious mind can't do that. "Full power to the engines Scotty." "But Cap'n she goin' to blow..."

To me some things are simple. Every day we go to sleep and don't really know what happens when we are unconscious. Even if we remember our dreams, we all know you can pack a lot into the 15 min between the alarm going off and a kid jumping on you, so who knows what goes on for 6-8 hours of sleep. Not surprising things get a little weird when we die for a few hours...

To Freebird, don't worry, it's a journey that gives you a great scar that any 11 yo boy would be in awe of , you get a ticking clock in your chest (Madam, I inhaled a clock, want to listen? Put your head on my chest.) plus you get LIFE!

 

[Catie]

Purely anecdotal re: my own experience ... My "math" brain left the building for weeks. It was quite disconcerting. I'm more of a word person anyhow, but simple math operations and other numbers-oriented things left me befuddled for awhile. I was cognizant of the deficit. Gratefully, things returned to normal after a while.

 

[raylock]

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 od

I guess my response is, if you do need a pace maker, so what? I was fitted with a pacemaker three months after my AVR. I was 75 then and 80 now. I never even think about it except for the yearly visit to the EP. Actually, it is sort of a comfort because when they read it out they can see everything that has gone on with your heart since the last read out. As a friend, who is the chief medical officer and a cardiologist/EP at a major hospital organization put it to me (speaking as a fellow pilot), When you are flying and in the clouds, be aware that the pacemaker will be the most reliable instrument in the airplane.

 

[pellicle]

if you do need a pace maker, so what?

I guess that its just one more new thing to come to terms with in the erosion of your health. Given the choice I'd rather have not needed a pacemaker (which I didn't) at 48. It does make changes to your lifestyle for a younger healthy active person, so ideally not is better ...

 

[raylock]

I guess that its just one more new thing to come to terms with in the erosion of your health. Given the choice I'd rather have not needed a pacemaker (which I didn't) at 48. It does make changes to your lifestyle for a younger healthy active person, so ideally not is better ...

Well, yes I would rather not have had to have it nor the AVR. But as an active older person, I have not noticed any changes in my lifestyle except that it was recommended that I not use a backpack leaf blower. But I may just be one of the lucky ones. It's just that I don't see any reason to dread heart surgery just because you may end up with a pacemaker. Happy holidays everyone.

 

[pellicle]

But as an active older person, I have not noticed any changes in my lifestyle except that it was recommended that I not use a backpack leaf blower.

contrary to the expectations of some, I don't research "everything" ;-) so I'd not researched pacemakers much and as it turns out there are quite some improvements in design:

A major step forward in pacemaker function has been to attempt to mimic nature by utilizing various inputs to produce a rate-responsive pacemaker using parameters such as the QT interval, pO2 – pCO2 (dissolved oxygen or carbon dioxide levels) in the arterial-venous system, physical activity as determined by an accelerometer, body temperature, ATP levels, adrenaline, etc. Instead of producing a static, predetermined heart rate, or intermittent control, such a pacemaker, a 'Dynamic Pacemaker', could compensate for both actual respiratory loading and potentially anticipated respiratory loading.​

which is far more adaptive than I'd anticipated.

I'm curious about the backpack blower, was that because of electrical interference or backpack in general, because until recently I did a fair bit of backpacking (both walking and skiing).

 

[epstns]

To return to the questions about pacemakers. . . I am among that 3% who did require a pacemaker. So what? Not meaning to be a smart a$$, just being direct. I have had a pacemaker now for almost 9 years. I still do everything I ever did before valve surgery, and more. In my case, I had a very calcified bicuspid valve. The surgeon (one of the top guys in the US for AVR) had to cut a bit wide around the old valve to get all the calcified tissue out. After surgery, I had severe heart rate and rhythm problems. They said they might be able to control it with meds, or could implant a pacemaker. I asked "Do you have a pacemaker on the shelf? What are we waiting for?"

Throughout recovery, rehab, and after, I remain a 5 days/week gym rat, doing far more than the average 72 year-old would ever think of doing. The pacemaker, once properly adjusted, is just not an issue (until you go through airport security).

Frankly, the only time I know I have it is when I look into a mirror with my shirt off. . .