title: Delirium after transcatheter aortic valve implantation via the femoral or apical route.
abstract: We thought that delirium might be less frequent after transcatheter aortic valve implantation via the femoral artery compared with via the cardiac apex. We reviewed 210 patients who underwent transcatheter aortic valve implantation between January 2009 and October 2014. The proportion (95% CI) of patients who suffered delirium in the 3 days after valve implantation were: 10 (3-16%) in 105 patients who had transfemoral implantation; and 35 (25-45%) in 105 patients who had transapical implantation, p = 0.0001. The variables that independently associated with postoperative delirium were age, male sex and the transapical approach. The median (IQR [range]) hospital stay was 7 (5-13 [2-41]) days and 10 (7-15 [2-64]) days, respectively, p = 0.004. Future trials should focus on different peri-operative management strategies to reduce delirium rates after transcatheter aortic valve implantation, particularly in older men having implantations via the cardiac apex.
authors.affiliation: St George's Hospital, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Katznelson
authors.affiliation: Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Horlick
authors.affiliation: Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Osten
authors.affiliation: Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Styra
authors.affiliation: Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: R J
authors.initials: RJ
authors.lastname: Cusimano
authors.affiliation: Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Carroll
authors.affiliation: Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Djaiani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000209:etiology*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods
keywords: elderly patients; postoperative delirium; transcatheter aortic valve implantation