Mended Hearts Open Forum

Hello everyone, my 83 year old father has been found to have 100% blockage in 2 major coronary arteries and 80% in the 3rd. He has been strongly advised CABG bypass surgery. He is without any symptoms on medication alone for the last 7 months, is mentally sharp and independent, but diabetic (controlled) and hypertensive (controlled). I read that cognitive decline is a common complication after CABG, lasting in 33-40% of patients at 1 year after the surgery. In a large percentage of patients with post-op cognitive decline, it never really goes away. This information has made me very concerned and anxious about my father's surgery. It seems like a hard choice of increasing quantity of life at the cost of quality. Can anyone throw any light on this issue or share any thoughts. I would appreciate it very much. Thanks.

Hi Suzanne,

I am not a physician and what I am about to tell you is purely anecdotal but you may find it helpful.  Five and a half years ago, I had a heart attack that required emergency quintuple bypass surgery.  I was 67 1/2 at the time and had been an active and athletic guy my entire life including up to (and after) the heart attack.

The surgery went well but I developed ventilator pneumonia and was kept in a medically induced coma for two weeks in order to reduce the strain on my heart.  When I awakened, I remained in the hospital for an additional week until I was transferred to an inpatient rehab hospital where I remained an additional three weeks.  The inpatient rehab included cardio rehab but was principally needed to get me walking and safely exercising again after having been comatose and, later, still bedridden for a three week period during which I had lost most of my muscle tone and didn't look at all like a weightlifter and former gymnast for the prior 55 years.  Part of my rehab included daily cognitive testing, at least for the first week or so.

I was advised by the psychologist doing the cognitive testing that cognitive issues were sometimes present post CABG surgery but not in all cases.  They were doing it in my case because they knew I was still working and wanted to make sure I was okay.  I was told that they wouldn't have bothered if I had been retired.  At the time, I was a partner at a large international law firm.  I thought it was unnecessary and proved it to them through a series of cognitive games and tests.

Based on my readings at the time, my understanding was and is that cognitive issues was a sometimes side effect of the surgery but that it tended to be temporary when it did occur.  Although I was approximately 15 years younger than your dad is now at the time of my surgery, I was still described in my medical chart as an "elderly gentleman" (which really infuriated me, lol) and, notwithstanding my "advanced" age, I was perfectly fine cognitively.  And I was fine even after having been in a medically induced coma for two weeks.  Most CABG patients are awaken several hours after surgery and start moving around shortly thereafter.

I do want to alert you to a mental phenomenon that I wouldn't characterize as cognitive and is very short lived and fairly commonplace in ICU patients whether or not they have had heart surgery…hallucinations/delusions. It's actually a condition described in the DSM-5 description of psychiatric conditions. I experienced these during my medically induced coma and for the following week that I was in the ICU. They immediately ceased when I went to the rehab hospital.  In my case, they were not at all unpleasant but were rather bizarre, but that is a story for another day.  Assuming that your father has the surgery, you should alert the nursing staff to watch out for any signs of these delusions as I understand that they can reduce or eliminate them with medication.  In any event, they likely will disappear on their own upon leaving ICU.

Best of luck to you and your dad and please keep us posted.

Ira

Of course everyone is different and outcomes vary but I haven't noticed any cognitive differences from my CABG surgery.  Like some others, I did go thru a short period of hallucinations during my recovery time in hospital.  But that stopped once they got me off the Fentanyl.  And, fwiw, my 98 year old father in law, who had a quadruple bypass at age 80, is just as mentally chipper now as he was in his youth.

My mom is 86 and had a quad in April of this year. She too has high BP and some kidney issues. So far i haven't seen any decline. She still lives alone, drives and very independent. 

------------------------------
Bryan Jefferson
Temple Hills MD
(301) 899-1648
------------------------------