Monday, January 23, 2006

Cognitive loss after bypass surgery

Minimizing trauma to the body's largest artery – the aorta – during heart bypass surgery can significantly reduce cognitive loss that often follows the operation, a team from Wake Forest University School of Medicine reported today.

Surgical technique is the primary cause of later thinking -- cognitive -- problems in coronary artery bypass graft patients, concluded the research team.

In the new study of 237 patients, the team compared the standard method of coronary artery bypass using the heart-lung machine with surgical techniques that minimized movement of the aorta while still using the machine. Movement was reduced by using a single clamp that exerted significantly less force on the aorta than the standard cross clamp. Surgery without the machine was also compared.

Six months after surgery, only 32% of the patients who didn't use the machine and 30% of the patients who had minimal aortic movement had deficits, suggesting less permanent injury in both groups. But 57% of the patients who had the traditional surgery still had deficits at 6 months, the researchers reported.

Other studies have shown that inflammation (our old enemy) increases the risk of cognitive impairment, possibly as a result of surgical stress. And, the preventive administration of the "smart drug", Instenon, significantly diminished the risk of cerebrovascular complication.

Would statins help? We know they're anti-inflammatory, however, in one study preoperative statin therapy did not decrease the inflammatory response to cardiopulmonary bypass or the cognitive dysfunction commonly seen after cardiac surgery.

So, if in need of bypass surgery, know the risks and discuss ways to minimize them with your doctor. Ask these questions:

  1. Is the surgery likely to prolong my survival?
  2. Are there any viable alternatives, such as medication, angioplasty, or stenting?
  3. If I must have bypass surgery, is there any reason I can’t have some form of minimally invasive surgery where the bypass pump is avoided?
  4. What can be done pre-operatively or intra-operatively to minimize my risks?

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