Postoperative delirium following transcatheter aortic valve implantation: a historical cohort study

Tse, Lurdes; Bowering, John; Schwarz, Stephan; Moore, Randell L.; Burns, Kyle D.; Barr, Alasdair M.

doi:10.1007/s12630-014-0254-2

Cited by 43 publications

(36 citation statements)

References 33 publications

(32 reference statements)

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“…The incidence of delirium after TAVI in our study (28.1%) is comparable to the incidence reported by previous studies examining delirium after TAVI (12–53%)14 15 or cardiac surgery (26–66%) 24–27. The observed incidence of delirium in our study may have been influenced by several factors: (a) transfer of the patient (from intensive care unit to cardiac care unit), (b) general anaesthesia, (c) strict patient follow-up by the geriatric consultation team and (d) preventive guidelines.…”

Section: Discussionsupporting

confidence: 89%

“…In addition, the access site may have influenced the incidence of delirium, as previous investigators showed difference in incidence of delirium related to the access site of the TAVI procedure (transfemoral vs transapical) 14. Moreover, the preventive use of haloperidol in 5/89 patients may have influenced the incidence of delirium.…”

Section: Discussionmentioning

confidence: 99%

“…Delirium frequently occurs after TAVI; incidence 12–53% 14–16. In-hospital delirium is associated with mortality, morbidity and increased costs, whereas it is often unrecognised and may be preventable in 30–40% of cases 17…”

Section: Introductionmentioning

confidence: 99%

“…20 In patients referred for TAVI, predictive models for delirium may be useful to identify high-risk patients, to allow treatment stratification and proactive implementation of preventive strategies 1721 Investigations were performed to identify risk factors associated with delirium after cardiac surgery, including TAVI 14–1620 Previous investigators found no relation between frailty and delirium after TAVI, however, in these studies variables of frailty were not objectively assessed 15…”

Section: Introductionmentioning

confidence: 99%

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Frailty is associated with delirium and mortality after transcatheter aortic valve implantation

et al. 2016

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ObjectiveWe hypothesised that frailty assessment is of additional value to predict delirium and mortality after transcatheter aortic valve implantation (TAVI).MethodsObservational study in 89 consecutive patients who underwent TAVI. Inclusion from November 2012 to February 2014, follow-up until April 2014. Measurement of the association of variables from frailty assessment and cardiological assessment with delirium and mortality after TAVI, respectively.ResultsIncidence of delirium after TAVI: 25/89 (28%). Variables from frailty assessment protectively associated with delirium were: Mini Mental State Examination, (OR 0.79; 95% CI 0.65 to 0.96; p=0.02), Instrumental Activities of Daily Living (OR 0.79; 95% CI 0.63 to 0.99; p=0.04) and gait speed (OR 0.05; 95% CI 0.01 to 0.50; p=0.01). Timed Up and Go was predictively associated with delirium (OR 1.14; 95% CI 1.03 to 1.26; p=0.01). From cardiological assessment, pulmonary hypertension was protectively associated with delirium (OR 0.34; 95% CI 0.12 to 0.98; p=0.05). Multivariate logistic analysis: Nagelkerke R2=0.359, Mini Mental State Examination was independently associated with delirium. Incidence of mortality: 11/89 (12%). Variables predictively associated with mortality were: the summary score Frailty Index (HR 1.66, 95% CI 1.06 to 2.60; p=0.03), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (HR 1.14, 95% CI 1.06 to 1.22; p<0.001) and complications (HR 4.81, 95% CI 1.03 to 22.38; p=0.05). Multivariate Cox proportional hazards analysis: Nagelkerke R2=0.271, Frailty Index and EuroSCORE II were independently associated with mortality.ConclusionsDelirium frequently occurs after TAVI. Variables from frailty assessment are associated with delirium and mortality, independent of cardiological assessment. Thus, frailty assessment may have additional value in the prediction of delirium and mortality after TAVI.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Frailty is associated with delirium and mortality after transcatheter aortic valve implantation

et al. 2016

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“…And although the list of possible risk factors for PD after SAVR remains long, the variables identified in this study such as age, a history of coronary artery disease, a need for an intra-aortic balloon pump preoperatively, and greater PRBC transfusions have all previously been cited as candidate risk factors for PD with on-pump surgery. 3,6,8,10,19 And although there are only a few studies available describing PD after TAVR, the data available thus far are consistent with those from this investigation suggesting that PD is an equally prevalent complication for TAVR, particularly when performed using alternative access techniques, 20,21 It is possible that despite the fact that TAVR may be a less-invasive procedure than SAVR, given the high-risk patient population for whom TAVR is currently restricted to as a procedural option, the incidence of PD following TAVR will remain high. The results from propensity-matched patients within this study suggest that a typical patient undergoing TAVR, with numerous comorbidities, would likely have an even higher likelihood of PD if offered an SAVR approach.…”

Section: Discussionsupporting

confidence: 85%

Delirium after surgical and transcatheter aortic valve replacement is associated with increased mortality

Maniar

Lindman

Escallier

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Objective The purpose of this study was to determine the incidence and clinical significance of postoperative delirium (PD) in patients with aortic stenosis undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Method Between 2010 and 2013, 427 patients underwent TAVR (n = 168) or SAVR (n = 259) and were screened for PD using the Confusion Assessment Method for the Intensive Care Unit. The incidence of PD in both treatment groups was determined and its association with morbidity and mortality was retrospectively compared. Results PD occurred in 135 patients (32%) with a similar incidence between SAVR (33% [86 out of 259]) and TAVR (29% [49 out of 168]) (P = .40). TAVR by transfemoral approach had the lowest incidence of PD compared with SAVR (18% vs 33%; P = .025) or TAVR when performed by alternative access techniques (18% vs 35%; P = .02). Delirium was associated with longer initial intensive care unit stay (70 vs 27 hours), intensive care unit readmission (10% [14 out of 135] vs 2% [6 out of 292]), and longer hospital stay (8 vs 6 days) (P < .001 for all). PD was associated with increased mortality at 30 days (7% vs 1%; P < .001) and 1 year (21% vs 8%; P < .001). After multivariable adjustment, PD remained associated with increased 1-year mortality (hazard ratio, 3.02; 95% confidence interval, 1.75–5.23; P < .001). There was no interaction between PD and aortic valve replacement approach with respect to 1-year mortality (P = .12). Among propensity-matched patients (n = 170), SAVR-treated patients had a higher incidence of PD than TAVR-treated patients (51% vs 29%; P = .004). Conclusions PD occurs commonly after SAVR and TAVR and is associated with increased morbidity and mortality. Given the high incidence of PD and its associated adverse outcomes, further studies are needed to minimize PD and potentially improve patient outcomes.

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The impact of delirium on healthcare utilization and survival after transcatheter aortic valve replacement

Huded

Sweis

et al. 2016

Cathet Cardio Intervent

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Postoperative delirium following transcatheter aortic valve implantation: a historical cohort study

Abstract: Patients undergoing TA-TAVI had a markedly increased incidence of postoperative delirium compared with patients undergoing TF-TAVI.

Cited by 43 publications

References 33 publications

Frailty is associated with delirium and mortality after transcatheter aortic valve implantation

Frailty is associated with delirium and mortality after transcatheter aortic valve implantation

Delirium after surgical and transcatheter aortic valve replacement is associated with increased mortality

The impact of delirium on healthcare utilization and survival after transcatheter aortic valve replacement

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