Delirium after TAVR: A common side effect linked to increased mortality
Postoperative delirium is a common side effect of transcatheter aortic valve replacement (TAVR), according to a new meta-analysis published in Annals of Medicine and Surgery.[1] One key takeaway from the study is that it is less common after transfemoral TAVR than other interventional techniques.
“Postoperative delirium can be described as an acute and fluctuating neurologic disorder that reflects an alteration from baseline cognition and is characterized by the important features of inattention and disorganized thinking,” wrote first author Sidhant Orchani, MBBS, with the department of medicine at Khairpur Medical College in Pakistan, and colleagues. “It is associated with increased mortality and prolonged hospital stays.”
Orchani et al. examined data from more than 47,000 TAVR patients who originally participated in one of 42 trials. All were over the age of 70 years old. The group focused on cases of in-hospital postoperative delirium (IHPOD), measuring it in two different ways, and stroke.
Overall, IHPOD was seen in approximately 10.5% of TAVR patients. Fifteen studies from the meta-analysis used Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scores to track IHPOD rates. Among just those studies, IHPOD was seen in 15.6% of TAVR patients.
In addition, researchers noted, IHPOD was seen in 9.3% of patients following transfemoral TAVR, but 25.3% of patients following non-transfemoral TAVR. The group provided several potential explanations for this trend.
“The incidence of IHPOD in patients undergoing non-transfemoral TAVR may be explained by various factors, including differences in patient profiles, comorbid conditions, medication side effects and the invasive nature of non-transfemoral TAVR,” the authors wrote. “Factors such as general anesthesia, postoperative pain and opioid use, prolonged hospitalization and systemic inflammation may also contribute to the increased incidence of IHPOD in non-transfemoral TAVR compared to transfemoral TAVR. Certain periprocedural or postprocedural factors such as stroke, cardiac tamponade, atrial fibrillation, and infections may also increase the risk of delirium after TAVR.”
Stroke, meanwhile, was seen in 3.7% of patients following TAVR. While more research is still needed, the study did seem to suggest that there is a relationship between patients who experience IHPOD after TAVR and those who experience a stroke.
The new meta-analysis was associated with certain limitations. It did not include data related to whether patients were treated with general or local anesthesia, for example, and it did not detail follow-up mortality rates. Even with these limitations, however, the authors believe their research helps paint a clearer picture of the likelihood of IHPOD after TAVR.
“Delirium should be assessed regularly, as a standard practice, since it is common after TAVR,” the authors wrote. They also advocated for “regular neurocognitive assessments of individuals undergoing TAVR” and suggested embolic protection devices as one way to potentially help patients reduce their risk of IHPOD and/or stroke.
Read the full study here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.