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A September 2000 New York Times article titled, \u201cSometimes Saving the Heart Can Mean Losing the Memory\u201d describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG.\xa0 The syndrome was termed \u201cpump head.\u201d\xa0 A doctor is quoted in the article as stating that older patients he might have previously considered CABG for he would try to manage medically, with a stent.\xa0 Data on the impact of CABG on cognitive function over the subsequent 20 years has been mixed.\xa0 The problem with these prior studies is they enrolled patients at the time of the CABG.\xa0 They didn\u2019t have a sense of what the cognitive trajectory was before the procedure.

In this context, enter Liz Whitlock\u2019s study published this week in JAMA comparing cognitive trajectories before and after CABG versus stenting procedures.\xa0 Liz finds no difference in the decline in memory before or after CABG vs PCI - in other words - their memory continued to decline at the same rate after each procedure as before.\xa0 Furthermore, a newer procedure intended to spare patients the risks of bypass, called \u201coff pump\u201d CABG, was found in this study to be associated with greater memory decline than on pump CABG.

Pump head, it seems, is not a thing.\xa0 Those who get CABGs likely also had vascular disease in the brian that was leading to a steady cognitive decline before the procedure.\xa0\xa0

To contextualize these findings for practicing geriatricians and other PCPs, we are joined by Mike Rich, one of the early movers and shakers in the field of geriatric cardiology.\xa0 We are doing these cardiac procedures on ever older and older patients.\xa0 What should we be concerned about?\xa0 How should we counsel our patients? Listen to find out!

-@AlexSmithMD