Aortic valve failure is a cardiac condition in which the aortic valve fails to open and close properly, negatively affecting healthy blood flow both to the brain and to the body.
There are two surgical methods currently that can restore normal aortic valve functioning.
The first surgical procedure involves replacing the aortic valve. The three types of replacement valve options are mechanical, porcine, and bovine. The bovine valve generally has the longest warranty, if you will, functioning well for about 10 years, while the mechanical valve has the shortest guaranteed functionality.
Replacing the aortic valve involves open-heart surgery, which requires that the recipient being in otherwise fairly good cardiac and general health to minimize the risk of serious complications or death, either during the surgery or after the surgery.
However, for patients with existing serious cardiac and/or general health problems, a second aortic valve replacement option that does not require open-heart surgery is available.
This procedure is known as transcatheter aortic valve replacement (TAVR). The procedure consists of using a catheter – usually through the femoral artery – to insert a flexible ring into the aortic valve to restore correct opening and closing of the valve.
But, even though TAVR is a less risky surgical option than open-heart surgery to replace the aortic valve, it poses significant short-term and long-term post-surgical risks.
These risks include blood clot formation and subsequent strokes immediately after the surgery (this is a common risk with femoral artery catheterization) and a higher likelihood of developing long-term small vessel ischemia (TIAs) resulting in microbleeds in the brain.
Additionally, the older a recipient of TAVR is, the higher these risks are.
Because small vessel ischemia affects the vascular functioning of the brain, a concurrent higher risk for cognitive impairment, decline, and dementia are also associated with TAVR.
Proper aortic valve functioning is a vital part of cardiac health, so this post is not discouraging surgical procedures to correct this malfunction.
However, as Going Gentle Into That Good Night‘s purpose is, in part, to educate, this post presents the information we need to know when and if we are faced with choosing a procedure to repair the aortic valve.
It’s been my experience that a lot of medical professionals tend to either downplay or hide the real risks associated with surgical procedures especially and that leads to either faulty choices for care or devastation when things – and they often do – go wrong after receiving care.
We should all be able to go in armed with the facts so that we can make the best decisions possible because all the risks are already known and on the table. Without that, we cannot be competent medical advocates for our loved ones and we will not be prepared for possible negative outcomes.
Going Gentle Into That Good Night 
Thank you for sharing. ..
I noticed changes in my father’s cognitive functioning after he had a knee replacement in 1997. He was fine, normal until the operation. Afterwards, his thinking was slower and his speech a bit garbled. You had to be patient with him. He was hearing impaired and in 2006 lost most of his sight with macular degeneration.
He was diagnosed with dementia late 2013, and admitted to high care dementia ward in January 2014. He passed last October, from a combination of the effects of dementia – he’d stopped eating – and a UTI; only five days after mum died from a cerebral haemorrhage (<24 hours).
Meanwhile, in 2014 my husband (then 79) had open heart surgery to repair a valve and for a single bypass. He healed well but I noticed changes in his memory and moods afterwards. Not his usual sunny self. He is a great reader and now is forgetting books he read only a matter of weeks ago. He passes the usual 'dementia' tests and his doctor says his forgetfulness is simply 'old age'.
To my eyes (and ears) the post-operative changes in these two men – the most important men in my life – were obvious. Not much I can do other than enjoy my husband's company and look after him as best I can for as long as I can!
Love your work.
I have also seen the post-operative changes, as you did with your dad and have with your husband, in the older people in my life. Mama had an aortic valve replacement about 11 years before some of her cognitive issues really began to be noticeable, but I suspect that her TIAs were more frequent after that (she’d always had them, even when we were kids…they were the result of stress). But after her pacemaker was put in 2009 was when it seemed that her dementias raced forward rapidly. Your husband is very fortunate to have you beside him…that is a blessing. Thank you for your comment and, as always, thank you for reading.
After TAVR, my mother is a shell of the person she was before the procedure.
Tamara, I am so sorry to hear about your mother in the aftermath of TAVR. Big hugs to you both.
The Dr’s keep talking like it was a success! Ummmm…”The operation was a success but the patient died” phrase comes to mind.