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Delirium is associated with higher mortality in transcatheter aortic valve replacement: systemic review and meta-analysis

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Abstract

Post-operative delirium (POD) has been recognized as an independent risk factor for mortality. Recent studies suggest that POD is associated with higher mortality rates in patients undergoing transcatheter aortic valve replacement (TAVR). However, a systematic review and meta-analysis of the literature has not been performed. This study assessed the association between POD and TAVR by performing a systematic review and meta-analysis of the literature. We comprehensively searched the databases of MEDLINE and EMBASE from inception to April 2018. Included studies were prospective or retrospective cohort studies that compared mortality among patients undergoing TAVR both with and without POD. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Seven studies consisting of 20,086 subjects undergoing TAVR (1517 with POD and 18,569 without POD) were included in this meta-analysis. POD demonstrated a trend towards higher all-cause mortality (pooled odd ratio 1.52, 95% confidence interval 0.98–2.37, p = 0.062, I2 = 72%). POD was associated with a significant increased long-term mortality (pooled odd ratio 2.11, 95% confidence interval 1.21–3.68, p = 0.009, I2 = 62.5%). POD was associated with an increased risk of long-term all-cause mortality in patients undergoing TAVR. Our study suggests POD could be a potential risk factor of mortality among patients undergoing TAVR. Further studies implementing preventative and treatment strategies against delirium and its effect on POD and its associated mortality are needed.

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Abbreviations

AS:

Aortic stenosis

CAM-ICU:

Confusion assessment method for the ICU

CHART-DEL:

Chart abstraction for delirium during hospitalization

CI:

Confidence interval

DSM-IV:

Diagnostic and statistical manual of mental disorder IV

EuroSCORE:

European system for cardiac operative risk evaluation

ICD:

International statistical classification of disease and related health problem

GA:

Generalized anesthesia

LA:

Localized anesthesia

NA:

Not available

OR:

Odds ratio

POD:

Post-operative delirium

SAVR:

Surgical aortic valvular replacement

STS:

Society of thoracic surgery

TAVR:

Transcatheter aortic valvular replacement

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Authors and Affiliations

  1. Internal Medicine Residency Program, University of Hawaii, 1356 Lusitana St, Honolulu, HI, 96813, USA

    Narut Prasitlumkum, Raktham Mekritthikrai, Jakrin Kewcharoen & Chanavuth Kanitsoraphan

  2. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Michael A. Mao

  3. Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA

    Wisit Cheungpasitporn

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  1. Narut Prasitlumkum
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NP: conception design, data interpretation, and draft manuscript, corresponding. RM: data acquisition and draft manuscript. JK: data acquisition and draft manuscript. CK: data acquisition and data interpretation. MAM: data interpretation and manuscript revision. WC: data interpretation and manuscript revision.

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Correspondence to Narut Prasitlumkum.

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Prasitlumkum, N., Mekritthikrai, R., Kewcharoen, J. et al. Delirium is associated with higher mortality in transcatheter aortic valve replacement: systemic review and meta-analysis. Cardiovasc Interv and Ther 35, 168–176 (2020). https://doi.org/10.1007/s12928-019-00592-y

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