Risk factors and outcome of postoperative delirium after transcatheter aortic valve replacement
POD is associated with a worse postoperative course in patients after cardiac surgery, but its incidence and effects after TAVR are not well-understood. The aim of the present study was to analyze incidence, risk factors, and in-hospital outcomes of postoperative delirium (POD) after transfemoral (TF-AVR) and transapical (TA-AVR) transcatheter aortic valve replacement (TAVR) in a nationwide cohort.
Methods and results
Administrative data on all patients undergoing isolated TAVR in Germany in 2014 were analyzed. 9038 TF-AVR and 2522 TA-AVR procedures were performed. POD incidence was 7% after TF-AVR and 12% after TA-AVR. Atrial fibrillation (TF: OR 1.35, p < 0.001; TA: OR 1.53, p = 0.001) and NYHA III/IV (TF: OR 1.23, p = 0.017, TA: OR 1.51, p = 0.001) were independent risk factors for POD. Dementia was a risk factor only in TF-AVR (OR 3.04, p < 0.001). Female sex was protective (TF: OR 0.56, p < 0.001, TA: OR 0.51, p < 0.001). We found the occurrence of POD to be associated with more postoperative complications such as stroke and bleeding. Consequently, patients with POD were ventilated and hospitalized longer and suffered an increased risk of in-hospital mortality (unadjusted OR TF: 1.83, p = 0.001, TA: 1.82, p = 0.01). After adjusting for postoperative events and comorbidities, POD’s effect on in-hospital mortality disappeared. In contrast, stroke and bleeding remained independent predictors for mortality irrespective of POD.
Patients with POD after TAVR are at increased risk for in-hospital mortality. However, after adjusting for postoperative events and comorbidities, stroke and bleeding, but not POD, are independent mortality predictors.
KeywordsTranscatheter aortic valve replacement (TAVR) Postoperative delirium In-hospital mortality Outcome
Coronary artery bypass graft
Coronary artery disease
International statistical classification of diseases
German procedure classification system
New York Heart Association-heart failure score
Peripheral artery disease
Transapical aortic valve replacement
Transfemoral aortic valve replacement
Transcatheter aortic valve replacement
We thank Angelika Gerlach and Marion Rüdiger for their excellent assistance in the acquisition of the data. Furthermore, we would also like to thank the staff of the Research Data Centers of the Federal Bureau of Statistics and the statistical offices of the federal states for providing the data and the technical support during the analysis.
The study was supported by internal funding of the University Heart Center Freiburg.
Compliance with ethical standards
Conflict of interest
JR works as a proctor for Edwards Lifesciences and Direct Flow Medical. All the other authors declare no conflicts of interest.
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