The Dangers of Cardiovascular Disease and the Surgery that Accompanies It
Film and TV star Bill Paxton’s death from complications following heart surgery points to the dangers that such procedures can carry, and lessons for people with cardiovascular disease.
Mr. Paxton’s family announced Sunday that the 61-year-old film and TV star has died from a fatal stroke following heart surgery.
“The bottom line with any open heart surgery is that there is always a small risk of stroke, but when it happens, it can be devastating,” says renowned cardiologist Dr. Chauncey Crandall.
Over the years, the safety heart surgery has improved but it still carries “about a 2% risk,” said Dr. Crandall, chief of the cardiac transplant program at the world-renowned Palm Beach Cardiovascular Clinic in Palm Beach Gardens, FL.
Note: Open-heart surgery is any type of surgery where the chest is cut open and surgery is performed on the muscles, valves, or arteries of the heart.
For such procedures, the heart is stopped, and the patient is put on a heart-lung machine, which is a mechanical pumping device that maintains the circulation and keeps oxygenated blood flowing to the body’s organs.
Although such surgery is considered safe, problems can occur at several steps along the way that could set the stage for a stroke, says Dr. Crandall.
One danger point occurs at the start of the surgery, when the heart’s aorta, which is the major cardiac vessel, is clamped, so the patient can be attached to the heart-lung machine.
“If you have heart disease within the aorta, this can cause the blood to clot, and the clot can travel to the brain and cause a stroke,” says Dr. Crandall.
“The aorta can be screened with an ultrasound test to see if there is disease present,” he says.
“This can be performed by the surgeon in the operating room prior to putting the patient on the heart-lung machine, but it is not commonly done,” he said.
Another dangerous time occurs surgical procedure is completed and the surgeon is prepares to take the patient off the heart-lung machine.
“When the patient is on the heart-lung machine, the heart is deflated. When the heart is restarted, the heart’s volume is increased and it begins to fill up with blood. But if there is any air in the chamber of the heart, that can form a stroke-causing blood clot,” says Dr. Crandall.
But even if everything appears to go well, a stroke can occur in the days just following the surgery. “Surgery causes changes in the blood, which can make it more likely to clot and result in a stroke.”
Open heart surgery can also raise the stroke risk if people already have carotid artery disease, a condition that narrows the blood vessels that carry blood to the brain and head.
To minimize such risks, Dr. Crandall offers these tips, as follows:
- Make sure the surgery is performed at a hospital that does a high volume of procedures. “High volume” means that a minimum of 250 open-heart operations is performed annually.
- Look for a veteran surgeon because they are more likely to be well trained and experienced in handling such cardiac emergencies.
- Be sure that the anesthesiologist is also well seasoned and experienced. The anesthesiologist is a critically important member of the open-heart surgery team.
- Make sure that you will be taken to recover in an intensive care unit that is well-staffed and supervised by a intensive care doctor at all times.
- Above all, make sure that the open heart surgery is actually needed.
“Get a second opinion from a cardiac interventionist. I often do stenting procedures on patients who were previously told they needed open-heart surgery but it turns out they didn’t,” he adds.
Notably, minimally invasive procedures like stenting carry significantly less risk.
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