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Link to Wall Street Journal article
In the United States alone nearly half a million people undergo
coronary artery bypass surgery (CABG) annually, and many, if not
most, will be permanently altered, mentally and emotionally, by
surgically induced brain damage. According to the authors of the
2008 Annals of Neurology article cited in today’s Wall
Street Journal article, “A review of contemporary studies
concludes that 30 to 65% of patients have evidence of cognitive
decline 1 month after surgery…. In one study of cognitive
outcomes after CABG, it was reported that 42% of the patients
had worse cognitive performance at 5 years than at baseline. The
occurrence of late cognitive decline 5 or more years after
surgery has been reported by other investigators, although some
studies have not found evidence of delayed decline several years
after CABG.”
The fatal insult to the patient’s non-replaceable nervous system
tissue is caused by microembolization—the release into the
circulation of thousands of tiny particles of debris. These
artery-blocking particles are created by the heart-lung machine
and by clamping the aorta. You can learn more about this damage
and see pictures of microemboli lodged in the arteries of
patients’ eyes (retinas) by reading this 2005
article in the American Heart Association’s journal
Circulation (Circulation.
2005;112:3833-3838.)
The reason for all the controversy about brain damage is heart
surgery is big business—$100 billion annually, with 80% of the
income of a typical hospital coming from the treatment of heart
disease. I believe money is the primary reason that patients and
their families are never informed about this expected
complication. Furthermore, I believe the primary motivation for
designing and publishing studies that create doubt in the minds
of doctors and patients is to preserve and protect the bypass
surgery business. Note that the authors of the 2008 Annals
of Neurology study are from the Departments of Neurology and
Surgery; Division of Cardiac Surgery, Johns Hopkins University
School of Medicine.
This 2008 Annals of Neurology study observed the mental
changes of two groups of patients from their institution over a
period of 6 years and found that although both groups showed
significant mental decline, there was no difference between
those who had had bypass surgery and those who did not. As a
result they concluded bypass surgery is not the cause of this
decline, but instead these mental changes are a result of normal
aging and underlying vascular disease (atherosclerosis).
How did they get those
results? The number of patients studied was small (244) and they
were exceptionally sick. Consider that 17% of the patients from
the surgery group and 21% of the non-surgery group died within 6
years, even with the best that medicine and surgery have to
offer. The main flaw of the study was that about 35% of both
groups were lost to follow-up. Patients lost to follow up in
this, and other studies, are the ones most likely to have
significant brain damage—the ones most needed to reach a valid
conclusion. (See the accompanying editorial by Yaffe ; Ann
Neurol 2008; 63:547-8).
In 2005 this same group from the John Hopkins University Cardiac
Surgery department published a similar article “disproving”
brain damage from bypass surgery (Neurology
2005;65:991-9). Although these findings did not appear in the
abstract—the synopsis portion of the article most doctors
read—they did state the following finding twice in their
publication: “At 3 months, both surgery groups (CABG and
off-pump) reported more changes for the worse in personality,
memory, and reading books (see table E-1). At 12 months, the
differences between the two surgery groups and the nonsurgical
cardiac controls in subjective symptom reporting persisted,
particularly the frequency of self-reported change in memory for
the CABG group.” So, they really did find evidence of brain
damage from CABG—maybe the researchers from the Cardiac Surgery
Department of John Hopkins have forgotten?
Certainly, heart surgery, even with all of the disadvantages of
the heart-lung bypass machine, is a modern medical miracle when
used to save and improve lives, like in the patients with
congenital heart defects and valve disease. But the lifesaving,
life-improving benefits of heart surgery do not apply to the
vast majority of the half million patients who undergo bypass
surgery annually. Neither angioplasty nor bypass surgery saves
lives (with a few debatable exceptions). You can read this same
conclusion in a recent Business Week article, “Is
Heart Surgery Worth It?”. The heartbreak caused by this
out-of-control business is compounded further by the fact that
the underlying disease is prevented and the artery blockages are
reversed with a sensible diet and a healthy lifestyle. But the
debate will continue because the threat of brain damage from
heart surgery would be a business-killer.
Read more about this subject in my newsletter articles:
September 2004:
What Next, Bill Clinton
April 2008:
Readers’ Comments on Bill Clinton’s Madness
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