80yr. Has a cerebrovascular event in the early perioperative stage of an open heart surgery operation. Abort operation or go on? The surgeon choose not to abort the operation to assess for the severity of injuries to the brain. The outcome of the operatio
I . I do not believe any physician reviewing this comment will be able to appreciate the condition of this patient going into surgery to assess the risk factors, rationale and options for treatment. I doubt that the surgeon would have known the patient was having a stroke during the cardiac procedure. It is not the usual practice of monitoring brain activity during cardiopulmonary bypass. Clearly there was significant cardiac problems, if indeed this patient required two valve repair/replacement, coronary artery bypass grafting and thromboendarterectomy. The fact that the patient suffered multiorgan system failure (as you suggest with the comment that there was "sustained irreversible vital organs damage"), suggests that the pump time was perhaps longer than usual, but understanding also that the organs of an 80 year old patient are fragile to start with. The finding of bilateral strokes on post-op day 3 would be consistent with events that occurred during or shortly after surgery, but likely not known during surgery. So unless there were other indications for the surgeon to abort, then continuing with the operation was understandable. I suggest you make an appointment with the surgeon to discuss your concerns and questions personally, to iron out any confusion or misunderstandings that exist and to bring closure to this case.
Tough choices. Lose lose. If one stops and the patient has a heart attack and dies that' s awful. If one proceeds and has a satisfactory heart operation and a damaged brain that is also awful. Many variables in play and only moments to decide in the scenario presented. We try to assess risks, benefits and make the best recommendations and actions.