It was about 13 years ago when I first I heard heart surgeons talk about what they called "pump head." They were talking about the cognitive deficits that they had seen among people who had heart bypass surgery. People who were once very sharp suddenly couldn't remember where they left their keys, or couldn't balance a checkbook. But I also learned that many people were never told about this possible complication before they had the surgery.
Today, a Wall Street Journal column addresses the phenomenon, building on the speculation that Bill Clinton became a pump-head after his heart surgery - something his aides deny.
The WSJ reports:
"Symptoms include short-term memory loss, slowed responses, trouble concentrating and emotional instability. In a landmark study published in the New England Journal of Medicine in 2001, researchers at Duke University Medical Center tested 261 patients before and after bypass surgery and found that 53% of them had significant cognitive decline when they were discharged -- and 42% still suffered from it five years later.
One explanation is that when a patient's blood is pumped through a heart-lung machine during bypass, tiny air bubbles, fat globules and other particles may enter the bloodstream. The pump can also damage platelets, which form clumps, and clamping the aorta loosens bits of plaque. That debris can travel to the brain and clog tiny capillaries, forming microscopic strokes."
Bottom line: in a true shared decision-making encounter, a physician should talk about the possibility of pump head or bypass brain with anyone considering bypass surgery.