Delirium After Transcatheter Aortic Valve Implantation Under General Anesthesia: Incidence, Predictors, and Relation to Long‐Term Survival

BACKGROUND/OBJECTIVES Prospectively collected data on postoperative delirium (POD) after transcatheter aortic valve implantation (TAVI) are scarce. The aim of this study was to report the incidence and risk factors of delirium after TAVI under general anesthesia and to assess the association of POD...

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Bibliographic Details
Published in:Journal of the American Geriatrics Society (JAGS) 2019-11, Vol.67 (11), p.2325-2330
Main Authors: Wulp, Kees, Wely, Marleen, Heijningen, Lars, Bakel, Bram, Schoon, Yvonne, Verkroost, Michel, Gehlmann, Helmut, Van Garsse, Leen, Vart, Priya, Kievit, Peter, Rikkert, Marcel Olde, Morshuis, Wim, Royen, Niels
Format: Article
Language:English
Subjects:
Aged, 80 and over
Anesthesia
Anesthesia, General - adverse effects
Aortic valve
Aortic Valve Stenosis - surgery
Clinical Investigation
Clinical Investigations
Delirium
Delirium - epidemiology
Delirium - etiology
Female
Fibrillation
Follow-Up Studies
general anesthesia
Geriatric Assessment - methods
Humans
Incidence
Male
Mental disorders
Mortality
Netherlands - epidemiology
Patients
Postoperative Complications
postoperative delirium
Prognosis
Prospective Studies
Risk Assessment - methods
Risk Factors
Survival
Survival Rate - trends
Time Factors
transcatheter aortic valve implantation
Transcatheter Aortic Valve Replacement - adverse effects
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Summary:BACKGROUND/OBJECTIVES Prospectively collected data on postoperative delirium (POD) after transcatheter aortic valve implantation (TAVI) are scarce. The aim of this study was to report the incidence and risk factors of delirium after TAVI under general anesthesia and to assess the association of POD with clinical outcome and short‐ and long‐term survival. DESIGN Prospective cohort study. SETTING Academic medical center. PARTICIPANTS A total of 703 subsequent patients undergoing TAVI under general anesthesia between 2008 and 2017. MEASUREMENTS Delirium was assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV), criteria. Outcomes were postprocedural clinical outcome and short‐ and long‐term survival (30 days and 5 years, respectively). RESULTS POD was observed in 16.5% (116/703), was the strongest independent predictor of long‐term mortality (hazard ratio = 1.91; 95% confidence interval [CI] = 1.36‐2.70), and was associated with impaired 30‐day and 5‐year survival (92.2% vs 96.8% [P = .025] and 40.0% vs 50.0% [P = .007], respectively). Stroke and new onset of atrial fibrillation were more often observed in delirious patients (6.9% vs 1.9% and 12.1% vs 5.1%, respectively). Strongest independent predictors of POD were prior delirium (odds ratio [OR] = 2.56; 95% CI = 1.52‐4.31) and aortic valve area less than 0.75 cm2 (OR = 2.39; 95% CI = 1.53‐3.74). CONCLUSION One in six patients experienced POD after TAVI under general anesthesia. POD was the strongest predictor of long‐term mortality and was associated with impaired short‐ and long‐term survival. Prior delirium and a more calcified aortic valve were the strongest independent predictors of POD. J Am Geriatr Soc 67:2325–2330, 2019
ISSN:0002-8614
1532-5415
DOI:10.1111/jgs.16087