Eckenhoff, Roderic
To:Al Rodbell
May 28 at 5:09 AM
Hi Al.
Thank you for your note, and your interest in this area. I
am sorry to hear about your heart disease, and the need for surgery.
I presume that the less invasive TAVR approach has been ruled out.
First, I think it is a good idea to get evaluated at a local memory
clinic to get a good baseline. The combination of your age, the
procedure and existing memory decline puts you at high risk for further
decline. However, most patients improve over 30
days to 3 months back to their expected trajectory.
This is a
combination of the beneficial aspects of the surgery (better cardiac
function and brain perfusion) as well as resolution of the negative
aspects of surgery (inflammation). The anesthetic plays only
a minor role, but it is important that your anesthesiologist know of
your concerns - as there are some medications to avoid, and some that
may help.
The UCLA anesthesia dept is very well versed in these issues,
and would be my choice for you. I am sorry that
I cannot be more definitive right now - much more research is needed.
Best, Rod
Roderic G. Eckenhoff, MD
Austin Lamont Professor of Anesthesia
Department:
Anesthesiology and Critical Care
Penn Medical
Dr. Eckenhoff,
I'm a 78 year old male with severe aortic regurgitation who has had
all of the evaluations preparatory to open heart surgery to replace the
valve -- which could be done in a few weeks. Non surgical intervention
is precluded for me.
I've never had a neurological examination that included a brain
MRI, genetic or biological workup. Over the last years, my short term
memory has declined, with names of friends, addresses, etc falling away,
which I'm aware is a common problem that trouble
people to different degrees.
My concern is that this operation could be the straw that breaks my
proverbial back, meaning cellular damage to my brain that now still
allows me to function. Predicting this, before any irreversible effects
of the operation, is what I am hoping to get
advice from you, based on your research at the cutting edge.
Perhaps you have colleagues in the San Diego area, or if needed,
L.A. who could do a workup that would be predictive of the effect of the
anesthesia, perfusion and trauma of the open heart process. It could
be I have a few years survival with my now early
stage heart failure, which could be preferable to a serious immediate
cognitive decline from the operation. As of now, I have a fairly
accurate prognosis of the former, but much less on the latter.
I welcome your response
Al Rodbell
Encinitas CA
