Pumphead: More On The Debate
In the past, I’ve written about a post-operative condition known as “pumphead“. The basic premise of pumphead is that patients on heart-lung machines for extended periods of time may experience cardiac depression and/or cognitive decline following surgery.
This has been somewhat of a heated debate in the medical community. Some researchers suggest pumphead is real and should be prevented / monitored. Other researchers believe that pumphead should not be attributed to cardiac bypass surgery.
Well, this morning I was reading an interesting article in a recent issue of Scientific American. The title of the story is “Pumphead: Does The Heart-Lung Machine Have A Dark Side?”. The article provides clinical information about pumphead and, more interesting, a very detailed patient story about this condition.
Again, my goal with posting this type of information is not to scare you. It is simply to inform you of certain, potential risks of heart surgery. So you know, my brain is functioning incredibly well after my aortic valve replacement. Yes, I did experience cardiac depression but I would not submit to you or anyone that I had pumphead.
I hope that helps!
Keep on tickin!
P.S. If you have any questions or comments, please click here.
About The Author: Adam Pick is a double, heart valve surgery patient and author of The Patient’s Guide To Heart Valve Surgery, a unique book which integrates the clinical facts of heart valve surgery with the personal experiences of 78 former valve surgery patients. To learn more about Adam and his heart valve surgery book, click here.
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January 23rd, 2009 at 9:27 am
I had Aortic Valve replacement last May and doing very well. Much to the credit of your book and support of this web site. Pumphead was a real fear of mine, but I did not suffer any of its effects. However, I have noticed subtle changes or variations in my personality and thought processes. These are not good or bad, just different. They may be the result of having survived such an intense experience or perhaps something more biological. I am not sure I can even explain it, but I know that I view certain people and situations very differently than before. I would be curious if someone else has had similar experiences and could put them in words better than myself
January 23rd, 2009 at 5:17 pm
I have to say I have had some issues since my surgery and pumphead is one of them. More specifically is mental confusion at times, memory issues and the big one was dull headaches. They have put me on Plavix and that has resolved a lot of the issues. But I had a more extreme surgery than most with the replacement of my aorta thru the arch. They actually completely stopped my entire body from functioning including my brain for 15 minutes. I think mine has more to do with that than just the bypass. i was also on bypass for a long time 6-8 hours is what they told us. But I do want everyone who is facing this that I am fine, I am alive, happy and able to do most anything. I little memory issues is not a big price to pay for my life. Keep your spirits up and look to the positives and the most important part find the best surgeon for the job, even if you have to travel to do the surgery. Oh and by the way I am only 4 months post surgery.
January 24th, 2009 at 3:37 pm
`Pumphead` can be minimised by vigilant management of cardiopulmonary bypass: maintaining a good pressure, not cooling below 34 degrees celcius, maintaining the blood concentration (hematocrit) above 25%, trying to keep the procedure brief (surgical skill!). Thesedays we also monitor the brain oxygen concentration (transcutaneous cerebral oxygen saturation), and adjust the parameters if it drops.
In coronary surgery, many surgeons thesedays perform the procedure without the pump (off pump coronary bypass).
Cardiac surgery is safe! (in good hands!) As Adam says, get second opinions to make sure your surgeon is OK. Even if you are going for a simple procedure, rather get the best surgeon in town.
Regards,
David Harris
Cardiac Surgeon
Cape Town, S Africa
January 24th, 2009 at 9:28 pm
I had aotic valve repair surgery and aorta replacement a little less than 5 months ago. The surgery went very well and my recovery has gone well. i returned to work roughly four weeks after surgery and was able to easily handle the analytical aspects of my finance job. I have to admit I’ve noticed some small issues with my memory, especially remembering names. I have no idea if this is due to ‘pumphead’. My wife believes it was simply the stress of the surgery and that I am getting better. As Bill said before, I feel some changes to my thought processes but not necessarily in a bad way. At the end of the day, I’m very happy the surgery was succesful and I am doing well.
January 25th, 2009 at 1:48 pm
Great comments on “pumphead” everybody.
Thanks so much for sharing your clinical and personal experiences Dr. Harris, Dan, Charlene and Bill!
Keep on tickin!
Adam
January 26th, 2009 at 6:54 am
I had Aortic valve replacement on 25/11/08 please talk to me about cardiac depression. I am a A type personality in the legal field that runs my own business and things have gone considerably wrong since my operation. Health wise all great - my mum has Altzheimers and is progressing rapidly and since my operation my main worker has taken sick leave due the to the stress of taking over the office whilst I have been sick. I am not coping very well which is highly unusual for me.
Is this normal? I just want to run away - if I could - I would. Please help.
February 1st, 2009 at 8:32 pm
My 80 year old uncle had an Aortic Valve Replacement May 5, 2008. He was on a ventilator for 9 days following surgery. He had severe cognitive difficulties following the procedure. We had to place him in a memory care center in his home sate of Nevada. In July, we moved him to Minnesota to be near us since he had no family in Nevada. He was having severe difficulty functioning. He has improved so much in the past 2 months that we moved him into an Assisted Living facility. He his returning to his home in Nevada to his own home next Sunday! Could that be a pumphead story?
February 16th, 2009 at 10:10 am
Hi from the UK.
Thanks for giving me the phrase “Pumphead”, it explains a lot. It is not a recognised expression this side of “the Pond”. I work with doctors on a regular basis and have tried it on them. The blank expression says it all! Throw in Cognitive Decline, and a little light come on, but very dimly and quickly glanced over or totally dismissed.
I had Aortic valve replaced along with a double bypass in June, 2008 (aged 59). Like most, the surgery was a great success, and after some tough weeks getting back on my feet with some semblance of energy, things began to pick up through Cardiac Rehab, exercise classes and a general fitness program. I returned to work 4 months after op, and now enjoy a couple of sessions per week at the gym. Physically, I am GOOD! Mentally, well, that is where “Pumphead” comes on to the scene. Memory loss, confusion, brain in a spin, mental exhaustion, anxiety attacks - they have all had their part over the months. Sometimes bad, sometimes easier, and I have to say as time marches on, symptons are getting milder. Each time a bout struck me, I was thrown - was it my op. failing? Could my heart cope with the palpitations and thumping valve? Was it just going to pop? Of course not. I knew in my head that it was not cardiac. I knew in my head that -well, it was in my head. But how do you cope with it? How do you convince yourself? More confusion. Have a lie down in a darkened room! Is there an answer?
And then, Adam, by chance, a few weeks ago I found your site - and, I found “Pumphead”. What a saviour. I am not alone in this world of “Brain fugg”. Your blogs have thrown up many answers to many problems. Of course, the symptoms are still there, but now I know why. There are answers, there are positives, and with that knowledge, I can go forward, perhaps more quickly. As I said, things are not as bad as they were initially, and I I am sure they will fade away completely, and if not totally, then at least I know why they are there, and, of course, how to deal with them. That, in itself is a cure - The understanding.
Is the medical fraternity on this side unaware, or just reluctant to explain. “your surgery was a success, now go and enjoy the rest of your life.” Yes, it does sound very promising and does give you a massive lift, but can also give you a massive fall when the old “Pumphead” kicks in and you have no idea what it is or what is causing it. NOW WE KNOW!
Thanks Adam, and thanks to your Bloggers. We are all in this together, and remember guys, we know there is light at the end of the tunnel. How long is that tunnel? As long as you allow it to be, I suppose. And of course, I must get my hands on your book.
Regards.