Recently, the world was saddened to learn of the surprising death from stroke of another famous Hollywood celebrity from heart-related issues.
On February 25, 2017, we learned that Mr. Bill Paxton passed away following complications following open heart surgery.
Bill Paxton was famous for acting in a number of Hollywood blockbuster hits including “Twister”, “Aliens” and “Titanic”.
At the present time, limited information is available to the public and press concerning Mr. Paxton’s death.
There are, however, enough clues to help us make some educated guesses about the circumstances surrounding his death. - and develop key lessons.
My goal is to take what we know from his heart-related issues and develop 5 heart health lessons about which heart patients and their families can become more educated, and that these 5 takeaways may help someone else.
Here is what we know: Mr. Paxton, age 61, reportedly passed away from a massive stroke at some point in time following open heart surgery to treat a diseased heart valve. Following the initial surgery, he had to return to surgery soon afterwards for a second procedure to “tune-up” the heart valve. At some point through this process, he was found to have had a massive stroke and then died. [reference]
Mr. Paxton had also reportedly told friends and family that his heart valve problem was related to an episode of rheumatic fever as a teenager.
Based simply on these set of circumstances alone, we can develop 5 takeaways that shed light on heart health and open heart surgery risks.
Lesson #1: Infections can cause damage to heart valves
As many of you know, there are two general types of infections: viral and bacterial.
There are two ways that bacterial infections can affect the valves of the heart.
The first is that bacteria circulating in our blood stream as a result of an infection can latch on to any of the heart valves as the bacteria within the bloodstream are pumped through the heart. The bacteria that attach themselves to the leaflets of the heart valves can replicate and either physically destroy the heart valve by forming an access or the bacteria can replicate to such a degree that they form a “vegetation” on the heart valve. This vegetation can get to the point where it mechanically interferes with the opening and closing of the heart valve leaflets.
Once the infection causes an access that dissolves the heart valve tissue, it is necessary to treat the access with open heart surgery and removing the infected heart valve and replacing it with an artificial heart valve.
A heart valve vegetation can sometimes be resolved with many weeks if intravenous antibiotics. Other times, the vegetation needs to be resected with open heart surgery because it is resistant to the intravenous antibiotics or is interfering with the function of the heart valve to such a degree that the valve function is so poor that it is compromising the heart function.
This is not what Mr. Paxton had.
Mr. Paxton experienced a different type of infection-related heart valve complication.
His comments about experiencing a bout of rheumatic fever as a teenager is important.
Rheumatic fever is an inflammatory process resulting from incompletely treated strep throat or scarlet fever.
The condition develops 2-4 weeks following an infection with streptococcus and causes the body to attack itself. Heart valve tissues are susceptible to this attack of inflammation and the lingering effects of this attack can lead to premature valve degeneration later in life.
According to the Mayo Clinic website, there are fewer than 20,000 cases of rheumatic fever each year in the United States.
The most common heart valve-related condition resulting from rheumatic fever is mitral stenosis, which is a narrowing of the mitral valve. Other heart valve-related problems are mitral valve insufficiency or aortic valve stenosis.
Without knowing which of these variants Mr. Paxton had, odds are that he developed mitral valve stenosis and underwent heart valve surgery to treat this problem.
Lesson #2: There are many different types of strokes
A stroke is not a heart attack.
A stroke refers to blood flow to the neurons of the brain and a heart attack refers to a disruption of blood flow to the heart muscle.
There are two types of strokes. An ischemic stroke and a hemorrhagic stroke. An ischemic stroke refers to a lack of blood flow to the brain tissue and a hemorrhagic stroke refers to bleeding within the brain that damages brain tissue.
The ischemic stroke can be embolic, meaning that a piece of plaque or calcium or clot breaks off near the heart and gets caught-up in the blood stream. The piece of debris is then swept into the small vessels of the brain and literally plugs an artery - shutting off blood flow to the region of the brain supplied by that particular artery that is blocked.
Another type of ischemic stroke refers to a disruption of blood flow in the microvascularature of the brain at the microscopic level.
Lesson #3: A stroke can occur as a result of heart surgery
The type of stroke that Mr. Paxton experienced occurred in association with his open heart surgery procedure.
As much as we all don’t like to acknowledge it, complications can happen with any type of surgery, even routine, straightforward surgery.
The overall stroke risk associated with single valve surgery is between 1.5 - 2%. That risk can increase depending on the age and existing health problems of the patient.
A stroke can occur during or after open heart surgery for a number of reasons. One reason is that a piece of plaque from inside the aorta can break off and be carried to the brain by natural blood flow. Cannualas or tubes are inserted into the aorta at the time of open heart surgery and when the tubes are inserted into the aorta, a piece of material can be flicked off.
Another potential way that a stroke can occur in association with open heart surgery is that an air bubble can unintentionally be pumped into the blood stream and travel to the brain. The circuit for open heart surgery is mean to be air-free, but sometimes an air bubble can develop in the circuit. This is extremely rare. The air bubble can then travel to the brain and cause damage to the brain tissue.
Small pieces of debris from the diseased valve can break off during the heart valve surgery and be swept up into the blood stream and travel to the brain. Precautions are instituted at the time of surgery to remove all debris, but some of the debris can be almost microscopic.
Blood thinners are given at the time of open heart surgery and even with appropriate blood thinning little pieces of clot can develop which can cause a stroke.
The heart-bypass machine controls the flow of blood in the body while the heart is stopped for the heart surgery. If the flow of blood by the heart-bypass machine is altered during the operation, there could be a temporary period of time when the brain is getting adequate blood flow.
With the administration of high doses of blood thinners, there is a small chance that there could be bleeding in the brain as a result of the thinness of the blood.
Lesson #4: There is an art and science to heart valve surgery
A diseased mitral valve can be surgically treated in a number of ways. Oftentimes the mitral valve can be repaired, meaning that the patient’s own tissue is used to reshape and modify the valve leaflets. The other alternative is an artificial valve replacement using either a mechanical prosthesis or a bioprosthesis from a cow or pig.
The fact that Mr. Paxton had to go back to surgery again for a “tune-up” implies that he originally had a valve repair and that the repair needed to be adjusted. A second open heart surgery rather soon after the first procedure does statistically increase the chances for a stroke to occur.
Lesson #5: Sometimes we never know the reason of cause of a poor outcome from open heart surgery
Those of us who perform open heart surgery procedures are all trained professionals.
Even in the best of hands and with meticulous attention to detail, unexpected complications can occur.
There are so many factors involved in making sure that an open heart surgery procedure goes smoothly that it is surprising that the number of complications are statistically so low.
Remember, that even when we state a range of statistical occurrence for an open heart surgery procedure, each patient’s risk varies on their type of heart problem, severity of the problem, type of heart surgery and associated individual risk factors that all contribute to a certain risk. profile.
Sometimes we can identify a certain factor or issue which contributed to the complication and other times we can’t.
We do our best to learn from every case and continuously strive to do better with each case, but some factors are out of our control.
We are constantly reviewing individual cases along with trends in outcomes to quickly identify any issues that may be going on.
The Society of Thoracic Surgeons Database is a national registry of cases that we are constantly benchmarking ourselves against to make sure our surgical outcomes are on par with other programs.
In summary, we don’t have a lot of information regarding Bill Paxton’s case, but from what we do know, we know that a stroke associated with open heart surgery for a valve problem occurred.
Patient’s and families need to know what a stroke is compared to a heart attack and that strokes can occur for a number of reasons. We will probably never know for sure what was the cause in Mr. Paxton’s case.
Feel free to pass this along to other people or family members who might benefit from this information.
For more information on Open Heart Surgery, feel free to check out my other website.
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