Each year, hundreds of thousands of Americans undergo coronary bypass surgery, and very few die. So, what happened to our national hero?
Neil Armstrong, the first man to walk on the moon, died in August 2012 at age 82 due to complications from coronary bypass surgery. Cincinnati hospital had to pay his family a $6 million for wrongful death settlement.
According to reports, Mr. Armstrong bled profusely into the membranes surrounding the heart when nurses removed wires attached to a temporary pacemaker. He dies soon after.
Last week, The Times disclosed and reviewed the medical details that have raised a few questions from both medical experts and readers.
Did Mr. Armstrong need open-heart surgery in the first place? What went wrong, and why?
The medical details revealed that he went to the hospital with complaints of severe chest pain. Some patients with chest pain caused by blocked arteries need stents to open them up. However, “It depends on what sort of blockage a person has,” said Dr. Michael Mack, a cardiac surgeon at Baylor Scott & White The Heart Hospital – Plano.
Mr. Armstrong had blockage in one of the major arteries called the left anterior descending artery, according to medical records reviewed by The Times. And the other two major arteries – the circumflex and the right coronary artery – were blocked completely.
Dr. Mack said, “You can’t put a stent in an artery that is completely occluded,” which was the case with Mr. Armstrong. The cardiac surgeon explained, “at least, it could not have been done a few years ago.” However, with advanced techniques, some experts can do it now.
Dr. Mack went on to say, “The blockages Mr. Armstrong had were probably not going to kill him, but they do result in chest pain, also called angina. So treatment was not life-or-death; it was a quality-of-life issue. That raises questions about whether Mr. Armstrong should have been rushed into surgery.”
Were there an alternative?
Another option was the medical therapy that includes treating the condition with medications, such as nitrates and beta-blockers, which can widen the coronary arteries.
“If it was me, I would try medical therapy first, but it depends on how severe the pain is,” said Dr. Mack.
Why did Mr. Armstrong get a temporary pacemaker?
When it comes to open-heart surgery, surgeons temporarily stop the patient’s heart so they can perform the surgery. They use a heart-lung machine for the heart to function.
In order to stop the heart, they infuse an icy solution into it. However, “the cold can dampen the heart’s electrical circuitry,” said Dr. Jonathan Haft, a cardiac surgeon from the University of Michigan. So, when doctors put patients off the heart-lung machine, the electrical circuits of the heart may get sluggish and the heartbeats get feeble.
Upon completing the surgery, surgeons sew fine wires onto the surface of the heart, leaving the bright blue or orange wires through the chest wall and skin. These wires are connected to a small box that generates electrical impulses to control the heart’s rhythm, which is called a temporary pacemaker.
The wires are removed gently once the heart’s electrical system is recovered. Usually, no harm is done most of the time.
So, what went wrong in Mr. Armstrong’s case?
Very rarely, when a nurse or healthcare expert removes one of the pacemaker wires, the wire may tear the heart surface, causing bleeding. “That usually occurs because the wire was stitched on too tightly, or someone pulled too hard,” said Dr. Mack.
Dr. Haft said, “At first, there may be no sign of a problem but as bleeding continues, blood pressure drops and the heart rate rises. The condition, called tamponade, occurs because blood is pooling around the heart and starting to clot. This inhibits the heart’s ability to relax and fill with blood.”
That happens extremely rarely. Dr. Haft said, “At the University of Michigan Hospital, which does thousands of open-heart surgeries annually, tamponade occurs once every several years.” It is so rare that nurses may not look for it. “You have to have a team that is prepared to look for it,” explained Dr. Haft.
Does a patient die if wire removal causes bleeding?
No, it is very rare, said the surgeons. Patients are rushed to the operating room to stop the bleeding and suction out the clots surrounding the heart.
However, “Mr. Armstrong was taken to a cardiac catheterization lab first, before he went to surgery. The cath lab, is not the solution,” said Dr. Haft. In the cath lab, doctors help remove some of the blood, but they will not be able to stop the bleeding or remove the clots. What happened next? So, by the time Mr. Armstrong got to the operating room, his heart had stopped and had brain damage due to lack of blood supply to his brain. Eventually, he died without regaining consciousness.
