Clinical Research in Cardiology

, Volume 107, Issue 9, pp 756–762 | Cite as

Risk factors and outcome of postoperative delirium after transcatheter aortic valve replacement

  • Peter Stachon
  • Klaus Kaier
  • Andreas Zirlik
  • Jochen Reinöhl
  • Timo Heidt
  • Wolfgang Bothe
  • Philip Hehn
  • Manfred Zehender
  • Christoph Bode
  • Constantin von zur Mühlen
Original Paper



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.


Transcatheter 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


Postoperative delirium


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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Peter Stachon
    • 1
  • Klaus Kaier
    • 2
  • Andreas Zirlik
    • 1
  • Jochen Reinöhl
    • 1
  • Timo Heidt
    • 1
  • Wolfgang Bothe
    • 3
  • Philip Hehn
    • 2
  • Manfred Zehender
    • 1
  • Christoph Bode
    • 1
  • Constantin von zur Mühlen
    • 1
  1. 1.University Heart Center Freiburg, Department of Cardiology and Angiology I, Medical FacultyUniversity of FreiburgFreiburgGermany
  2. 2.Faculty of Medicine and Medical Center-University of FreiburgInstitute of Medical Biometry and StatisticsFreiburgGermany
  3. 3.University Heart Center Freiburg, Department of Cardiovascular Surgery, Medical FacultyUniversity of FreiburgFreiburgGermany

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