Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Stachon, P; Kaier, K; Zirlik, A; Reinöhl, J; Heidt, T; Bothe, W; Hehn, P; Zehender, M; Bode, C; von Zur Mühlen, C.
Risk factors and outcome of postoperative delirium after transcatheter aortic valve replacement.
Clin Res Cardiol. 2018; 107(9):756-762
Doi: 10.1007/s00392-018-1241-3
Web of Science
PubMed
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- Co-Autor*innen der Med Uni Graz
- Zirlik Andreas
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- Abstract:
- POD is associated with a worse postoperative course in patients after cardiac surgery, but its incidence and effects after TAVR are not well-understood. The aim of the present study was to analyze incidence, risk factors, and in-hospital outcomes of postoperative delirium (POD) after transfemoral (TF-AVR) and transapical (TA-AVR) transcatheter aortic valve replacement (TAVR) in a nationwide cohort. Administrative data on all patients undergoing isolated TAVR in Germany in 2014 were analyzed. 9038 TF-AVR and 2522 TA-AVR procedures were performed. POD incidence was 7% after TF-AVR and 12% after TA-AVR. Atrial fibrillation (TF: OR 1.35, p < 0.001; TA: OR 1.53, p = 0.001) and NYHA III/IV (TF: OR 1.23, p = 0.017, TA: OR 1.51, p = 0.001) were independent risk factors for POD. Dementia was a risk factor only in TF-AVR (OR 3.04, p < 0.001). Female sex was protective (TF: OR 0.56, p < 0.001, TA: OR 0.51, p < 0.001). We found the occurrence of POD to be associated with more postoperative complications such as stroke and bleeding. Consequently, patients with POD were ventilated and hospitalized longer and suffered an increased risk of in-hospital mortality (unadjusted OR TF: 1.83, p = 0.001, TA: 1.82, p = 0.01). After adjusting for postoperative events and comorbidities, POD's effect on in-hospital mortality disappeared. In contrast, stroke and bleeding remained independent predictors for mortality irrespective of POD. Patients with POD after TAVR are at increased risk for in-hospital mortality. However, after adjusting for postoperative events and comorbidities, stroke and bleeding, but not POD, are independent mortality predictors.
- Find related publications in this database (using NLM MeSH Indexing)
- Aged, 80 and over -
- Aortic Valve Stenosis - surgery
- Delirium - epidemiology
- Delirium - etiology
- Female -
- Germany - epidemiology
- Humans -
- Incidence -
- Male -
- Postoperative Complications - epidemiology
- Risk Assessment - methods
- Risk Factors -
- Transcatheter Aortic Valve Replacement - adverse effects
- Find related publications in this database (Keywords)
- Transcatheter aortic valve replacement (TAVR)
- Postoperative delirium
- In-hospital mortality
- Outcome