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

Abstract

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.

• Authors: Hersh S Maniar, Brian R Lindman, Krisztina Escallier, Michael Avidan, Eric Novak, Spencer J Melby, Marci S Damiano, John Lasala, Nishath Quader, Ravinder Singh Rao, Jennifer Lawton, Marc R Moon, Daniel Helsten, Michael K Pasque, Ralph J Damiano Jr, Alan Zajarias
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 151 Issue 3 Pg. 815-823.e2 (Mar 2016) ISSN: 1097-685X [Electronic] United States
• PMID: 26774165 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Aortic Valve Stenosis (diagnosis, mortality, therapy)
• Cardiac Catheterization (adverse effects, methods, mortality)
• Delirium (diagnosis, etiology, mortality, therapy)
• Female
• Heart Valve Prosthesis Implantation (adverse effects, methods, mortality)
• Humans
• Incidence
• Intensive Care Units
• Kaplan-Meier Estimate
• Length of Stay
• Logistic Models
• Male
• Middle Aged
• Missouri (epidemiology)
• Multivariate Analysis
• Patient Readmission
• Propensity Score
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome