Travelling with heart failure: risk assessment and practical recommendations
Professor Recovering From 'dissection Of The Aorta' After Heart Surgery
Philosophy Professor Daniel Dennett was rushed to the hospital from the Medford campus n an ambulance in late October. On Nov. 3, he posted an entry in his online blog describing his condition.
Upon arriving at the hospital, Dennett underwent a CT scan which found he had "a dissection of the aorta," he wrote on the blog. "The lining of the main output vessel carrying blood from my heart had been torn up, creating a two-channel pipe where there should only be one."
Dennett had a coronary artery bypass graft seven years ago, which, he wrote, may have saved his life.
Surgeons operated on Dennett's heart for nine hours. During this time, "my heart was stopped entirely, and my body and brain were chilled down to about 45 degrees to prevent brain damage from lack of oxygen until they could get the heart-lung machine pumping," he wrote.
Now, Dennett has a new aorta and aortic arch, which is made out of Dacron fabric tubing. The surgeon sewed the tubing into shape during the procedure and attached it to his heart by a carbon fiber valve. According to the blog, this makes a small click every time that Dennett's heart beats.
Dennett was teaching two undergraduate courses this semester, "Philosophy of the Mind" and "Computational Models of Consciousness."
Senior Alex Kelston, who is double majoring in philosophy and quantitative economics, is in "Computational Models of Consciousness." While Dennett was in the hospital, Professor Ray Jackendoff, who heads up the cognitive studies section of the philosophy department with Dennett and has been co-teaching the class for the entire semester, took over instruction of the class, Kelston said.
"We were a little lost without [Dennett]," said Kelston. "When Dennett left, it left us without the leadership we needed."
According to Kelston, Dennett has been back in class for about two weeks now, but only part-time. The class meets on Thursdays and Fridays, but Dennett only attends the Thursday meeting.
"He seems lively and engaged," Kelston said. "He has said that [class] is helping his recovery process because it keeps his mind going.
"I'm extremely glad he's back and doing well," he said.
According to Kelston, Dennett is on campus for short periods of time.
"Right after class he goes right back to the hospital [or wherever he is getting care]," he said. "They pick him up outside the philosophy department."
Dennett was not available for comment by press time, and colleagues who are familiar with his condition did not respond to multiple requests to comment.
- Sarah Butrymowicz and James Bologna
Coronary Artery Disease And Coronary Bypass Surgery
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During this operation, the surgeon will make an incision, called a median sternotomy, in your chest and through the breastbone.
They will take healthy vessels from another part of your body to 'bypass' the blocked arteries that are preventing oxygenated blood from efficiently reaching your heart. A healthy artery in your chest may be used, or veins from your leg can be taken and used to bypass the blockage. In order for your surgeon to obtain the healthy veins, one or two small incisions are made in the leg.
During most open-heart surgeries it is necessary to connect you to a heart-lung bypass machine. During this time, your heart will stop. This machine takes over the work of the heart, oxygenating your blood and circulating it throughout the body. Your heart will begin beating again once the procedure is complete.
No Significant Benefit Of IV Exenatide In Reducing Complications During Cardiac Surgery, Finds GLORIOUS Trial
A large-scale clinical trial found that intravenous infusion of exenatide, a glucagon-like peptide-1 (GLP-1) analog medication, during heart surgeries involving bypass did not significantly reduce the risk of death, stroke or organ failure. Researchers presented this preliminary late-breaking science trial today at the American Heart Association's Scientific Sessions 2024. The meeting, Nov. 16-18, 2024, in Chicago, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.
Exenatide is a GLP-1-like (analog) medication primarily prescribed to treat Type 2 diabetes, approved by the U.S. Food and Drug Administration in 2005. The GLORIOUS trial tested whether intravenous infusion of exenatide could reduce complications during and after cardiac surgery that included the assistance of cardiopulmonary bypass.
Health care professionals frequently perform heart surgery with the assistance of cardiopulmonary bypass, also known as a heart-lung machine. During this procedure, the blood is drained from the veins through a pump, passed through an oxygenator that adds oxygen and removes carbon dioxide, and pumped back into the body through the aorta. The process allows the body and organs to continue to receive oxygen-rich blood and function, while the surgeon operates on a non-moving heart. While helpful, there are still risks to bypass, including death, stroke, kidney failure and new or worsening heart failure. Previous research has suggested that exenatide might have organ-protective effects, the authors noted.
"The evidence for perioperative treatment of patients undergoing cardiac surgery is limited," said investigator Sebastian Wiberg, M.D., Ph.D., an anesthesiologist at The Heart Centre, Copenhagen University Hospital Rigshospitalet in Copenhagen, Denmark. "As such, there is a large unmet need for clinical trials investigating strategies to optimize treatment and reduce the risk of complications, such as organ injury, inflammation and the formation of blood clots."
The GLORIOUS trial included approximately 1,400 adults who had cardiopulmonary bypass-assisted coronary bypass grafting and/or surgical aortic valve replacement at a heart center in Denmark between 2016 and 2021, with the final follow-up visit completed in June of 2024. The study was a randomized, double-blind, placebo-controlled clinical trial, meaning participants were randomly assigned to receive a test treatment or a sham/placebo treatment, and neither the researchers nor the participants knew which group participants were in. Patients were randomized to one of two groups: to receive either a six hour and 15-minute infusion of exenatide or a placebo prior to surgery.
The study found no significant differences in outcomes between the two groups during the average follow-up period of nearly six years:
"We had hoped exenatide might protect patients from developing heart failure or other common complications after heart bypass surgery, however, the results suggest that this GLP-1 analog does not offer significant benefits. Of note, these findings provide important insights into what does and doesn't work in the complex setting of cardiac surgery," Wiberg said. "There is still a big gap in knowledge about how to best support patients on bypass during surgery, and there is an urgent need for more clinical trials to find ways to optimize patient health during and after bypass surgery."
Wiberg emphasized that because the trial assessed the effects of a single treatment with exenatide over a relatively brief administration period at one heart center in Denmark, the results may not be generalizable to other medications among different patient populations. In addition, it's possible that different GLP-1 analogs, administration for a longer period of time or a larger dose may potentially be beneficial for patients undergoing cardiopulmonary bypass-assisted cardiac surgery.
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