Interventional cardiology

Nightmares for octogenarians after heart surgery

Post-operative delirium is common and overlooked among elderly patients undergoing aortic valve replacement, research suggests.

The study involving in-depth interviews with 10 post TAVR/SAVR patients aged in their eighties revealed that some patients had brief episodes of delirium while others had distressing and uncomfortable feelings that lasted for days and weeks after their procedure.

One patient explained about how a red lamp in their room caused horrifying feelings for eight days.

According to the authors, diary notes kept by the patient that meticulously documented her reflections on the nightmares she had over the days post operation were an effort to regain control in an ‘incomprehensible’ situation.

“Apparently I was lying in a coffin,” recounts another patient, “and I remember saying to myself; at least I could have been covered by a duvet. It is the strangest feeling”.

A third patient described this hallucination:

“There was this kind of pipe along the ceiling. It was fully packed with crawling animals. Suddenly, it became worse and the wall started to move towards me … I panicked and screamed out in such a tone of voice that the nurses wouldn’t let me into their office.”

Researchers say that vulnerability to post-operative delirium increases with age but delirium often goes unrecognised by physicians and nurses because symptoms can be mistaken with dementia and age-related cognitive impairment rather than to an acute change in mental state.

But given the participants’ strong, persistent, and distressing memories of their delirious state, as well as the serious nature of the condition itself, the investigators say it’s important to identify delirium at an early stage after TAVI or SAVR.

They recommend initiating a preoperative information program to identify potential risk factors and provide a natural opportunity to inform octogenarian patients of some of the challenges they might encounter postoperatively.

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