making a decision on behalf of my mother

[Clucky64]

My mother needs an Aortic Valve replacement TAVI but she also lives with Dementia. It seems the procedure is risky in that it can accelerate the dementia. The family have to decide if the procedure should go ahead knowing the risks. Does anyone have any experience of this? Thank you

[Lopas]

I would not presume to tell you what to do.... my father was in a not dissimilar situation aged 80+ although it was an aorta problem rather than a heart valve so significantly more invasive..

As well as talking to the medical staff we had a discussion with a social worker. The discussion was more about what would he understand of what was being done to him, secondly the risks of the operation versus the long term prognosis (especially given his age) , and thirdly the wishes of my mother.... he did not have the operation.

I feel for you, certainly "not easy"

[Clucky64 in reply to Lopas]

Thank you for reply., Your response is very helpful, much appreciated

[NotanAstronaut]

I think this is a really difficult decision for you.

I think you need to consider what her cardiac health is like now. How symptomatic is she? What are the expectations if she does not have surgery?

If she does have surgery, what benefits would she gain? Would she be expected to live longer? And would she be less symptomatic (and so more comfortable) from a cardiac point of view?

You don’t say how severe her dementia is at present so I’m not sure if she has capacity herself to decide whether to have the surgery or not or whether you have a health power-of-attorney to be able to decide that for her. It may be wise to speak to her GP about the prognosis for her dementia without surgery although you are only likely to get broadbrush answers because every patient is different.

Whilst a deterioration in her dementia may be a risk of surgery I would have thought the norm would be that there is little risk because otherwise everybody who had the procedure would have a cognitive deterioration and I don’t believe that is the case

This is purely a personal point of view and it may be a bit unfair but that is that doctors often want to do more than is truly better for some patients in the long-term.I think that’s because they don’t want to be seen to under offer treatments. Clearly, I don’t know anything about your mother but my view is there is a time for saying no more active treatment or no more big procedures. Whether she and you have reached that point, only you can know. When my own mother had dementia we reached it about six months before she died.

I hope this helps.

[Clucky64 in reply to NotanAstronaut]

Thank you. The Dementia is in its early stages and she is symptomatic with breathing issues related to the heart problem. If she returns home her chances are 50/50 of surviving 6 months to a year. The procedure should prolong her life for a couple of years without the breathing difficulties. Mum doesn’t have capacity to make the decision. As a family we have decided that it’s in her best interest, for a better quality of life, to proceed with the replacement valve. It’s been a tough and stressful time having to make the decision. Thanks again

[NotanAstronaut]

Thanks for replying. That sounds a good rationale for going ahead. I hope it goes well.