Las Vegas doctors say Bill Paxton’s death from stroke related to heart surgery is rare occurrence

The sudden death Feb. 25 of actor Bill Paxton, reportedly of a stroke that occurred either during or after heart surgery, highlights what doctors say is a real but relatively uncommon risk of the procedure.

Dr. Fareed Sheikh, a cardiologist with Dignity Health and St. Rose Dominican hospitals, said that while a stroke can happen with any surgery, it’s most often associated with cardiovascular surgery. Occurrence is “1 to 2 percent, if that. Not a lot,” he said. “But when it does happen, it’s devastating.”

Paxton — whose most memorable credits include “Titanic,” “Twister,” “Aliens” and the cable series “Big Love” — was 61. News reports have noted that Paxton last month said on Marc Maron’s podcast that he had rheumatic fever as a child, a bacterial infection that can damage the heart and heart valves.

But, Sheikh said, “for someone who’s otherwise healthy — no heart failure, just an isolated valve — it should actually be routine and I’m kind of surprised that it happened.”

Dr. Paul Janda, a neurologist and president of the Las Vegas chapter of the American Heart Association, said the risk of post-surgical stroke varies with “the type of surgery and the degree of surgery.”

“The risk of stroke is highly dependent on the patient’s baseline physical status,” Janda said. “If you have a patient who’s entirely healthy, with no risk factors, it would be more odd for them to have a stroke versus a patient with a lot of stroke risk factors.”

Such risk factors include high blood pressure, diabetes, obesity and sleep apnea, he said.

Strokes that occur during or after surgery can result from several conditions, including an irregular heart rhythm that “compromises circulation to the brain,” or too-low blood pressure, Sheikh said.

A stroke also can be a product of stopping and restarting the heart during cardiac surgery and having the patient on a heart-lung machine in the interim. During those procedures, a blood clot can form in the heart, or plaque from the aorta can dislodge and travel to the brain, blocking blood flow, Sheikh said.

Then, an area of the brain “is not getting blood flow, not getting oxygen, and brain tissue dies very quickly. And less than six minutes, if you don’t restore the flow to the brain, you can get permanent damage,” he added.

“A patient’s status when entering (surgery) is a strong indicator of the outcome of the stroke,” Janda said. “That is why we, as doctors, do cardiac clearances, we do our best to clear patients (before surgery), because what we do as physicians is risk-benefit analysis to see if the benefits of the surgery outweigh any risks of the surgery.”

Sheikh noted that pre-surgical clearances — which typically include an electrocardiogram and also may include ultrasound imaging and even a cardiac stress test — now are routine for just about any surgery.

Then, he said, ”we look at how we can mitigate those risk factors during surgery.”

Read more from John Przybys at reviewjournal.com. Contact him at jprzybys@reviewjournal.com and follow @JJPrzybys on Twitter.