Decline in Mental Function Seen After Bypass Surgery

The statistics are distressing. Eighty-one million Americans suffer from cardiovascular disease, making it our nation's leading cause of death for both men and women. Every year, 1.5 million people suffer a heart attack in the U.S., killing 1 out of every 3 people, or approximately 1 million per year.

Considering these facts, it's no surprise that coronary artery bypass graft surgery (CABG) is one of the most common types of surgery performed with over 500,000 procedures done every year in the United States alone. Taking into account that physicians and specialists have received little or no nutritional training and are unaware of how an aggressive dietary approach can alleviate angina and reverse heart disease, they deem this highly invasive and costly procedure as the only option for patients experiencing chest pain due to inadequate blood flow.

Many patients also want a "quick fix" so that they won't have to put forth any effort of their own making diet and lifestyle changes, believing that bypass surgery will "cure" their heart disease. However, this procedure does not protect against future cardiac tragedies, nor does it improve chances of survival in the vast majority of cases. In fact, bypass surgery comes with many serious risks, one of which is immediate or post-operative death. As a doctor who believes that patient education is of utmost importance, this blog is the first of many that will examine and disclose the potentially hazardous outcomes associated with coronary artery bypass graft surgery.

One such risk following CABG is a decline in mental function either immediately after or in the months following surgery. Information concerning cognitive dysfunction and decline was not widely discussed within the scientific medical community or disclosed to patients in the past. I appreciate Dr. John McDougall's candidness in discussing this "carefully guarded medical secret" in two of his articles and a book:

Dr. McDougall's articles explain how the traditional cardiopulmonary bypass (heart and lung) pump keeps the patient alive by circulating the blood and filling the lungs with air. As blood is being pumped through the plastic tubing, Dr. McDougall points out that toxic chemicals, air bubbles, clumps of fat, and small foreign materials such as flakes of plastic or metal from equipment, can break off and be introduced back into the patient's bloodstream — injuring blood cells and platelets — causing diffuse microembolization (clumps). Dr. McDougall writes: "Once they are in the bloodstream, these particles migrate to the brain where they can clog capillaries and prevent adequate amounts of blood and oxygen from flowing to the brain. Essentially, all patients experience brain emboli during surgery and for many the damage is permanent."

Clamping the aorta, which is necessary to obtain a vein graft, may also loosen calcified plaque debris, thus releasing it into the bloodstream.

Dr. McDougall cites numerous medical studies showing that nearly 100 percent of patients suffer from some form of central nervous system dysfunction or detectable brain damage immediately after these products are released back into the bloodstream, affecting brain tissue and spinal fluid. "Decline in mental function is most severe right after surgery" says Dr. McDougall. "At the time of discharge from the hospital, between 50% and 80% of patients are having troubles."

"Three years after their time on the bypass pump, significant permanent reduction in mental capacity was identified in 31% of patients. In 2001, an article in the New England Journal of Medicine reported that 5-years after bypass surgery 42% of patients showed decline in mental function of approximately 20 percent or more."

Degrees of intellectual impairment include: difficulty in remembering names and numbers, loss of memory and intellectual acuity, confusion, problems concentrating for lengthy periods, sleep disturbances (including nightmares), mood swings, depression with suicidal thoughts, and personality changes in which the slightest irritation may invoke a rage.

Dr. McDougall emphasizes that during his 40 years of practicing medicine, he has never met a patient that had been informed of this complication before their surgery. He's even confronted numerous heart surgeons and cardiologists — all of which "minimized the importance of this damage and many have denied it even occurs—denied it to me and to their patients." In his article, Dr. McDougall says that even though decline in brain function has been reported in medical journals since 1969, brain damage caused during bypass surgery is one of the best-kept secrets in medicine and that it's so common, hospital personnel refer to it as "pump head."

I applaud Dr. McDougall's efforts for providing patients with this very important information. For those interested in seeing a few of the references he cites, I've provided a short list of notes below:

"Adverse cerebral outcomes after coronary bypass surgery are relatively common and serious." Complications are associated with 5 to 10 times increased mortality, 2 to 4 times the time spent in intensive care and in the hospital, and 3 to 6 times the need for prolonged care.
"Neurologic and neuropsychological dysfunction are now recognized as major causes of morbidity following cardiac surgery." Disabilities in this study ranged from "difficulty in managing normal everyday activities to being severely disabled to the extent that they would have been unable to manage an independent existence." A few of the disabilities included: psychosis consisting of a paranoid-hallucinatory state, dysfunction of other peripheral nerves, nystagmus, impaired coordination, ophthalmologic abnormalities, depressed reflexes, transient drowsiness, abnormalities in motor and visuospatial performance, decreased attention span, concentration, and auditory memory.

"It is estimated that even one out of three patients undergoing CABG in the perioperative period can develop symptoms of depression."
Central nervous system infarctions, psychiatric problems including post-operative delirium were noted.
"Neurological complications were recorded in 64% of the patients 24 hours after the operation."
Lost drive, mental slowness, forgetfullness, decreased attention and visuospacial and motor skills, anxiety, nervousness and reduced reaction time and psycomotor speed were reported in this study.
"Neuropsychological and EEG deficits were found in 48% of patients 1 week after surgery and in 34% 2 months after surgery."
"Impairment in learning and memory, reduced ability to pay attention and concentrate, and psychomotor slowing impairment in some cognitive functions could still be found at 6 months after CABG surgery."
"One week after surgery, most deficit was found in tests of attention and psychomotor performance using right, left and both hands simultaneously."

Additional studies can be seen in Dr. McDougall's above mentioned articles and book.

The most alarming tragedy of all is that conventional medical treatment for blocked coronary arteries involves such an extreme measure to remedy a disease caused entirely by what we choose to put at the end of our forks. Atherosclerotic cardiovascular disease only occurs in those countries that consume a diet based on meat, dairy, and highly-refined foods such as oils, sugars, and processed (packaged) foods. This disease is nearly non-existent in those countries that consume a diet based on whole, natural plant foods. The good news is that this deadly disease can not only be prevented, it can be reversed by eating a diet consisting of a wide variety of whole grains, starchy vegetables, beans, colorful fruits and vegetables and especially green leafy vegetables. See my article, Who has Heart Disease? Everyone? for more details.