Delirium after transcatheter aortic valve implantation : a retrospective chart review of associated risk factors and outcomes

A retrospective chart review was performed to determine the incidence and risk factors of delirium after transfemoral and transapical transcatheter aortic valve implantation (TAVI), and open-heart aortic valve replacement (AVR) (n = 45 per group). A number of secondary outcomes were also compared between the surgeries, including 24-hour, 30-day, 1-year and 2-year mortality; time spent in intensive care; total length of hospitalization; need for emergency cardiopulmonary bypass during operation (for TAVI procedures only); and frequencies of postoperative complications. Delirium occurred significantly less frequently in transfemoral TAVI (16%) than in transapical TAVI (51%) or open-heart AVR (38%) (p < 0.01 for transfemoral vs. transapical; p < 0.05 for transfemoral vs. open-heart). There were no significant differences in the use of emergency cardiopulmonary bypass between the two TAVI procedures. Transapical TAVI patients required longer periods of intensive care compared to transfemoral or open-heart patients (84 ± 118.4 hours for transapical compared to 36 ± 36.9 hours for transfemoral and 41 ± 32.1 hours for open-heart; p = 0.014 for transapical vs. transfemoral; p = 0.025 for transapical vs. open-heart), and transfemoral patients had significantly shorter lengths of hospitalization (8 ± 6.0 days for transfemoral compared to 14 ± 9.5 days for transapical and 11 ± 7.2 days for open-heart; p = 0.001 for transfemoral vs. transapical; p = 0.047 for transfemoral vs. open-heart). The 2-year cumulative mortality rate was significantly lower for open-heart patients than for TAVI patients (2% of open-heart patients, compared to 20% of transapical patients and 18% of transfemoral patients; p = 0.007 for transapical vs. open-heart; p = 0.014 for transfemoral vs. open-heart). Transapical and open-heart patients suffered from more postoperative complications than transfemoral patients. A large number of risk factors for delirium were also identified within each surgical group. This study demonstrated that benefits are incurred with transfemoral TAVI compared to transapical TAVI and compared to open-heart AVR. The contribution of medications taken in the perioperative period on the outcome of postoperative delirium is discussed, and clinical considerations with regards to using TAVI for mitigating the incidence of delirium are mentioned.Medicine, Faculty ofAnesthesiology, Pharmacology and Therapeutics, Department ofGraduat