Universität zu Köln

Mauri, Victor, Reuter, Kevin, Koerber, Maria I., Wienemann, Hendrik, Lee, Samuel ORCID: 0000-0001-6768-7079, Eghbalzadeh, Kaveh, Kuhn, Elmar, Baldus, Stephan, Kelm, Malte, Nickenig, Georg, Veulemans, Verena, Jansen, Felix, Adam, Matti and Rudolph, Tanja K. (2021). Incidence, Risk Factors and Impact on Long-Term Outcome of Postoperative Delirium After Transcatheter Aortic Valve Replacement. Front. Cardiovasc. Med., 8. LAUSANNE: FRONTIERS MEDIA SA. ISSN 2297-055X

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Abstract

Background: The aim of the present study was to analyze incidence, risk factors, and association with long-term outcome of postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR). Methods: Six hundred and sixty one consecutive patients undergoing TAVR were prospectively enrolled from January 2016 to December 2017. POD was assessed regularly during ICU-stay using the CAM-ICU test. Results: The incidence of POD was 10.0% (n = 66). Patients developing POD were predominantly male (65%), had higher EuroSCORE II (5.4% vs. 3.9%; P = 0.041) and were more often considered frail (70% vs. 26%; P < 0.001). POD was associated with more peri-procedural complications including vascular complications (19.7 vs. 9.4; P = 0.017), bleeding (12.1 vs. 5.4%; P = 0.0495); stroke (4.5 vs. 0.7%; P = 0.025), respiratory failure requiring ventilation (16.7% vs. 1.8%; P < 0.001), and pneumonia (34.8% vs. 7.1%; P < 0.001). Consequently, patients with POD had significantly longer ICU- (7.9 vs. 3.2 days P < 0.001) and hospital-stay (14.9 vs. 9.0 days; P < 0.001), and higher in-hospital mortality (6.1 vs. 2.1%; P = 0.017). Logistic regression analysis identified male sex (odds ratio (OR) 2.2 [95% confidence interval (CI) 1.2-4.0); P = 0.012], atrial fibrillation [OR 3.0 (CI 1.6-5.6); P < 0.001], frailty [OR 4.3 (CI 2.4-7.9); P < 0.001], pneumonia [OR 4.4 (CI 2.3-8.7); P < 0.001], stroke [OR 7.0 (CI 1.2-41.6); P = 0.031], vascular complication [OR 2.9 (CI 1.3-6.3); P = 0.007], and general anesthesia [OR 2.0 (CI 1.0-3.7); P = 0.039] as independent predictors of POD. On Cox proportional hazard analysis POD emerged as a significant predictor of 2-year mortality [HR 1.89 (CI 1.06-3.36); P = 0.030]. Conclusion: POD is a frequent finding after TAVR and is significantly associated with reduced 2-year survival. Predictors of delirium include not only peri-procedural parameters like stroke, pneumonia, vascular complications and general anesthesia but also baseline characteristics as male sex, atrial fibrillation and frailty.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mauri, Victor UNSPECIFIED UNSPECIFIED UNSPECIFIED Reuter, Kevin UNSPECIFIED UNSPECIFIED UNSPECIFIED Koerber, Maria I. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wienemann, Hendrik UNSPECIFIED UNSPECIFIED UNSPECIFIED Lee, Samuel UNSPECIFIED orcid.org/0000-0001-6768-7079 UNSPECIFIED Eghbalzadeh, Kaveh UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhn, Elmar UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Kelm, Malte UNSPECIFIED UNSPECIFIED UNSPECIFIED Nickenig, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Veulemans, Verena UNSPECIFIED UNSPECIFIED UNSPECIFIED Jansen, Felix UNSPECIFIED UNSPECIFIED UNSPECIFIED Adam, Matti UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Tanja K. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-589198
DOI:	10.3389/fcvm.2021.645724
Journal or Publication Title:	Front. Cardiovasc. Med.
Volume:	8
Date:	2021
Publisher:	FRONTIERS MEDIA SA
Place of Publication:	LAUSANNE
ISSN:	2297-055X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/58919