ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Thursday, December 19, 1996 TAG: 9612190035
SECTION: NATL/INTL PAGE: A-10 EDITION: METRO
DATELINE: BOSTON
SOURCE: Associated Press
ABOUT 3 PERCENT of these operations trigger strokes that cause permanent damage, while another 3 percent result in a sharp loss of intellectual abilities very similar to moderate Alzheimer's disease, a study says.
Heart bypass surgery causes serious, lingering brain damage in a surprisingly high number of patients - perhaps 25,000 Americans a year, a major study found.
Doctors have long noticed that some people have trouble thinking and remembering clearly while recovering from heart bypass surgery. However, surgeons traditionally have contended that these patients almost always eventually regain their mental edge.
The new study contradicts this view, suggesting that in 6 percent of cases, patients' brains are significantly - and perhaps permanently - harmed by the operation.
The study found that about 3 percent of these operations trigger strokes that cause permanent impairment, while another 3 percent result in a sharp loss of intellectual abilities very similar to moderate Alzheimer's disease.
``That's a frightening figure for an elective procedure,'' said the study's director, Dr. Dennis Mangano of the San Francisco Veterans Affairs Medical Center.
He said these patients' impairment was so striking that they are unlikely to recover fully. Many more probably suffer milder degrees of loss that would show up on careful neurological testing, which was not done in this study.
An estimated 400,000 Americans - and 800,000 people worldwide - will undergo bypass surgery this year, often to relieve chest pain. Doctors sew in new pieces of blood vessel to reroute blood around blockages in the heart arteries.
Doctors believe the surgery can harm the brain by dislodging bits of fatty deposits in the arteries, as well as releasing pieces of blood clots and even air bubbles produced by the machine that circulates the blood during surgery. The debris blocks tiny blood vessels in the brain, starving it of oxygen.
Doctors caution that the findings do not necessarily mean people are always better off getting balloon angioplasty or medicines alone for their heart trouble. They say bypass can be a lifesaving operation that in many cases may be worth the risk.
The study was based on a follow-up of 2,108 non-emergency bypasses at 24 of the country's most prestigious surgery centers, including hospitals affiliated with Harvard, Stanford and Yale. The results were published in today's issue of the New England Journal of Medicine.
Among the most common problems seen: Eight patients died of brain injury, 55 suffered nonfatal strokes, 55 had significant loss of intellectual ability that was still apparent when they were released from the hospital, and eight had seizures.
The doctors said the loss of intellect included a pronounced deterioration in concentration and memory. Those who were mentally normal before the surgery were left confused and agitated, unable to recall phone numbers, focus on conversations or do many of the things that had come easily to them.
``People who were once great bridge players can't win a game anymore,'' said Dr. Katherine Marschall of New York University.
Dr. Philip Wolf of Boston University, a stroke specialist not involved in the study, called the degree of brain injury seen in the research surprisingly high.
``And you know it's a gross underestimation, because these people were not seen systematically by a neurologist,'' he said. ``It must be the tip of the iceberg.''
However, Dr. Robert Replogle of Harvey, Ill., president of the Society of Thoracic Surgeons, said the study exaggerated the risk. ``I personally have not seen patients who are not able to function perfectly well and whose families are not happy with them,'' he said.
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