Background
Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation
(TAVI) are increasingly performed in octogenarian patients with severe aortic stenosis
(AS), including those with high surgical risk. Postoperative delirium (PD) is a common
and serious complication in older patients, characterised by reduced awareness, change
in consciousness, disturbance in logical thinking and hallucinations.
Methods
To explore how octogenarian patients experienced PD, a qualitative study was conducted
including five women and five men between 81 and 88 years. The incidence of PD was
assessed for five days using the Confusion Assessment Method. Cognitive function was
assessed preoperatively and at a 6-month follow-up using the Mini-Mental State Examination.
In-depth interviews were conducted 6–12 months post-discharge, transcribed, and analysed
using Giorgi’s phenomenological method.
Results
Postoperative delirium experiences were grouped into six themes: “Like dreaming while
awake”, “Disturbed experiences of time”, “Existing in a twilight zone”, “Trapped in
medical tubes”, “Moving between different surroundings” and “Meeting with death and
the deceased”.
Conclusions
For the first time, we show that octogenarian patients who undergo SAVR or TAVI have
strong and distressing memories of their delirious state that can persist for up to
12 months later. These findings provide valuable new information that will likely
improve delivery of health services and enhance professional and empathic care of
octogenarians after SAVR and TAVI.
Keywords
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Article info
Publication history
Published online: March 21, 2017
Accepted:
February 5,
2017
Received:
December 23,
2016
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
