title: Postoperative delirium following transcatheter aortic valve implantation: a historical cohort study.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) techniques show favourable survival outcomes in high-risk patients, but the incidence of postoperative delirium is unknown. We conducted a historical cohort study to compare postoperative delirium in retrograde transfemoral (TF) versus anterograde transapical (TA) TAVI procedures. We also sought to identify independent predictors of delirium following TAVI.
  
  
  METHODS
  We performed a retrospective chart review on all patients who underwent TF (n = 77) or TA (n = 45) TAVI during 2008 and 2009 at St. Paul's Hospital (Vancouver, BC, Canada), the pioneering centre for these procedures. The primary outcome was a documented physician diagnosis of delirium. Abstracted data included information on demographics, medical history, surgical procedure, anesthesia, and postoperative care. We employed a multivariable logistic regression to identify independent predictors of delirium.
  
  
  RESULTS
  Delirium occurred in 12% of TF patients vs 53% of TA patients (P < 0.001). Preoperatively, the groups differed significantly in the rates of hypertension, pulmonary hypertension, dyslipidemia, peripheral vascular disease, congestive heart failure, previous myocardial infarction, and memory impairment. Differences in anesthetic management were also observed between the TF vs TA groups regarding inhalational anesthetics, opioids, neuromuscular blockers, antihemorrhagic drugs, and antibiotics. Independent predictors for delirium after TAVI included coronary artery disease (odds ratio [OR] 12.7; 95% confidence interval [CI] 1.0 to 154.9), cognitive impairment (OR 6.5; 95% CI 1.8 to 23.2), and cardiac arrhythmia (OR 3.5; 95% CI 1.1 to 11.6). Compared to the TF approach, TA-TAVI independently increased the risk of delirium (OR 13.8; 95% CI 3.3 to 59.0).
  
  
  CONCLUSIONS
  Patients undergoing TA-TAVI had a markedly increased incidence of postoperative delirium compared with patients undergoing TF-TAVI.
authors.affiliation: Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Medical Sciences Block C, 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
authors.forename: Lurdes
authors.initials: L
authors.lastname: Tse
authors.forename: John B
authors.initials: JB
authors.lastname: Bowering
authors.forename: Stephan K W
authors.initials: SK
authors.lastname: Schwarz
authors.forename: Randell L
authors.initials: RL
authors.lastname: Moore
authors.forename: Kyle D
authors.initials: KD
authors.lastname: Burns
authors.forename: Alasdair M
authors.initials: AM
authors.lastname: Barr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*