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Delirium after surgical and transcatheter aortic valve replacement is associated with increased mortality.
J Thorac Cardiovasc Surg. 2016 Mar; 151(3):815-823.e2.JT

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+Show Affiliations

Division of Cardiothoracic Surgery, Department of Surgery, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo. Electronic address: maniarh@wudosis.wustl.edu.Division of Cardiology, Department of Medicine, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Department of Anesthesia, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Department of Anesthesia, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Division of Cardiology, Department of Medicine, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Division of Cardiothoracic Surgery, Department of Surgery, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Division of Cardiology, Department of Medicine, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Division of Cardiology, Department of Medicine, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Division of Cardiology, Department of Medicine, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Division of Cardiology, Department of Medicine, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Division of Cardiothoracic Surgery, Department of Surgery, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Division of Cardiothoracic Surgery, Department of Surgery, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Department of Anesthesia, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Division of Cardiothoracic Surgery, Department of Surgery, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Division of Cardiothoracic Surgery, Department of Surgery, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.Division of Cardiology, Department of Medicine, Barnes Jewish Hospital/Washington University School of Medicine, St Louis, Mo.

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26774165

Citation

Maniar, Hersh S., et al. "Delirium After Surgical and Transcatheter Aortic Valve Replacement Is Associated With Increased Mortality." The Journal of Thoracic and Cardiovascular Surgery, vol. 151, no. 3, 2016, pp. 815-823.e2.
Maniar HS, Lindman BR, Escallier K, et al. Delirium after surgical and transcatheter aortic valve replacement is associated with increased mortality. J Thorac Cardiovasc Surg. 2016;151(3):815-823.e2.
Maniar, H. S., Lindman, B. R., Escallier, K., Avidan, M., Novak, E., Melby, S. J., Damiano, M. S., Lasala, J., Quader, N., Rao, R. S., Lawton, J., Moon, M. R., Helsten, D., Pasque, M. K., Damiano, R. J., & Zajarias, A. (2016). Delirium after surgical and transcatheter aortic valve replacement is associated with increased mortality. The Journal of Thoracic and Cardiovascular Surgery, 151(3), 815-e2. https://doi.org/10.1016/j.jtcvs.2015.10.114
Maniar HS, et al. Delirium After Surgical and Transcatheter Aortic Valve Replacement Is Associated With Increased Mortality. J Thorac Cardiovasc Surg. 2016;151(3):815-823.e2. PubMed PMID: 26774165.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delirium after surgical and transcatheter aortic valve replacement is associated with increased mortality. AU - Maniar,Hersh S, AU - Lindman,Brian R, AU - Escallier,Krisztina, AU - Avidan,Michael, AU - Novak,Eric, AU - Melby,Spencer J, AU - Damiano,Marci S, AU - Lasala,John, AU - Quader,Nishath, AU - Rao,Ravinder Singh, AU - Lawton,Jennifer, AU - Moon,Marc R, AU - Helsten,Daniel, AU - Pasque,Michael K, AU - Damiano,Ralph J,Jr AU - Zajarias,Alan, Y1 - 2015/11/11/ PY - 2015/05/16/received PY - 2015/10/11/revised PY - 2015/10/21/accepted PY - 2017/03/01/pmc-release PY - 2016/1/18/entrez PY - 2016/1/18/pubmed PY - 2016/7/12/medline KW - TAVR KW - aortic stenosis KW - aortic valve replacement KW - cardiac surgery KW - delirium SP - 815 EP - 823.e2 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 151 IS - 3 N2 - 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. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/26774165/Delirium_after_surgical_and_transcatheter_aortic_valve_replacement_is_associated_with_increased_mortality_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(15)02215-1 DB - PRIME DP - Unbound Medicine ER -