Expert: Ronald Levy, M.D. - 5/12/2008

Question
My grandmother, who is 90 years old, just had a her aortic valve replaced and she is doing fine physically. What I am worried about is her confusion and loss of memory after surgery.  She is very confused about where she is and at times her vision is not good(she sees things, what is on the wall she sees on the floor and it becomes blurry. She talks about things that did not happen and constantly thinks she is in her own house. She is aware that she just had surgery, she knows her name and date of birth and all that good stuff, but I am becoming very worried that she will not return to normal.  She is a very sharp and active 90 year old.  Are these normal reactions and will they stop?

Answer
I won't say the reactions are normal but they are not abnormal or unexpected. There are several things that contribute to the condition that your grandmother is in. First is the fact that she had open heart surgery. During the surgery they stop your heart and put you on a heart-lung machine. There have been several studies that have shown a link between mental status changes and being on the heart-lung machine (particularly with valve surgery). A second factor is called sundowning which is common in patients in the ICU (more common in elderly patients).Most of the time these symptoms resolve over a few weeks but in some they persist. I am sure your heart surgeon can give you more details about these penomena.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston