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Ma X, Chu H, Han K, Shao Q, Yu Y, Jia S, Wang D, Wang Z, Zhou Y. Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta-analysis. J Am Geriatr Soc 2023; 71:646-660. [PMID: 36419366 DOI: 10.1111/jgs.18104] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/19/2022] [Accepted: 09/24/2022] [Indexed: 11/25/2022]
Abstract
AIMS To perform an updated systematic review and meta-analysis of postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR). METHODS We conducted a systematic literature search of PubMed, Embase, and Cochrane Library databases from the time of the first human TAVR procedure in 2002 until December 24, 2021, which was supplemented by manual searches of bibliographies. Data were collected on incidence rates, risk factors, and/or associated mortality of POD after TAVR. Pooled analyses were conducted using random effects models to yield mean differences, odds ratios, hazard ratios, and risk ratios, with 95% confidence intervals. RESULTS A total of 70 articles (69 studies) comprising 413,389 patients were included. The study heterogeneity was substantial. The pooled mean incidence of POD after TAVR in all included studies was 9.8% (95% CI: 8.7%-11.0%), whereas that in studies using validated tools to assess for delirium at least once a day for at least 2 consecutive days after TAVR was 20.7% (95% CI: 17.8%-23.7%). According to the level of evidence and results of meta-analysis, independent preoperative risk factors with a high level of evidence included increased age, male sex, prior stroke or transient ischemic attack, atrial fibrillation/flutter, weight loss, electrolyte abnormality, and impaired Instrumental Activities of Daily Living; intraoperative risk factors included non-transfemoral access and general anesthesia; and acute kidney injury was a postoperative risk factor. POD after TAVR was associated with significantly increased mortality (pooled unadjusted RR: 2.20, 95% CI: 1.79-2.71; pooled adjusted RR: 1.62, 95% CI: 1.25-2.10), particularly long-term mortality (pooled unadjusted HR: 2.84, 95% CI: 1.91-4.23; pooled adjusted HR: 1.88, 95% CI: 1.30-2.73). CONCLUSIONS POD after TAVR is common and is associated with an increased risk of mortality. Accurate identification of risk factors for POD after TAVR and implementation of preventive measures are critical to improve prognosis.
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Affiliation(s)
- Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huijun Chu
- Department of Anesthesia, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Kangning Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qiaoyu Shao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuo Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dunliang Wang
- Department of Anesthesia, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Goldfuss S, Wittmann S, Würschinger F, Bitzinger D, Seyfried T, Holzamer A, Fischer M, Camboni D, Sinner B, Zausig YA. Anaesthesia-related complications and side-effects in TAVI: a retrospective study in Germany. BMJ Open 2019; 9:e025825. [PMID: 31048439 PMCID: PMC6501997 DOI: 10.1136/bmjopen-2018-025825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 02/19/2019] [Accepted: 02/28/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study was performed to analyse anaesthesia-related complications and side effects in patients undergoing transcatheter aortic valve implantation (TAVI) under general anaesthesia. DESIGN Retrospective study. SETTING The study was performed as a single-centre study in a hospital of tertiary care in Germany. PARTICIPANTS All 853 patients, who underwent TAVI at the Universitätsklinikum Regensburg between January 2009 and July 2015, were included. 52.5% were female patients. PRIMARY AND SECONDARY OUTCOME MEASURES We gathered information, such as recent illness, vital parameters and medication administered during the intervention and postoperatively for 12 hours. We analysed all anaesthesia-related complications and anaesthesia-related side effects that occurred during the intervention and entire hospital stay. RESULTS We analysed all 853 TAVI procedures. The mean patient age was 79 ± 6 years. In 99.5% of cases, we used volatile-based anaesthesia. 2.8% (n=24; transfemoral (TF): n=19 [3.8%]; transapical (TA): n=5 [1.4%]) of all cases suffered from anaesthesia-related complications. 819 (TF: n=447; TA: n=372) anaesthesia-related side effects occurred in 586 (68.7%, TF: n=325 [64.2%], TA: n=261 [75.2%]) patients. Neither the complications nor the side effects had any serious consequences. Intraoperative hypothermia in 44% of cases (TF: n=202 [39.9%]; TA: n=173 [49.9%]) and postoperative nausea and vomiting in 27% (n=232; TF: n=131 [25.9%], TA: n=101 [29.1%]) of cases were the most common anaesthesia-related side effects. CONCLUSION In this study, serious anaesthesia-related complications were rarely seen, and non-critical anaesthesia-related side effects could have been avoided through consistent prophylaxis and management. Therefore, despite their high anaesthetic risk, general anaesthesia is justifiable in patients who underwent TAVI.
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Affiliation(s)
- Sophia Goldfuss
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Sigrid Wittmann
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Fabian Würschinger
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Diane Bitzinger
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Timo Seyfried
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Andreas Holzamer
- Department of Cardiothoracic Surgery, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Marcus Fischer
- Department of Cardiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Daniele Camboni
- Department of Cardiothoracic Surgery, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Barbara Sinner
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - York Alexander Zausig
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
- Department of Anaesthesiology and Operative Intensive Care Medicine, Klinikum Aschaffenburg, Aschaffenburg, Germany
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Abawi M, Pagnesi M, Agostoni P, Chiarito M, van Jaarsveld RC, van Dongen CS, Slooter AJC, Colombo A, Kooistra NHM, Doevendans PAFM, Latib A, Stella PR. Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. J Am Geriatr Soc 2018; 66:2417-2424. [PMID: 30296342 DOI: 10.1111/jgs.15600] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/01/2018] [Accepted: 08/15/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the incidence of in-hospital postoperative delirium (IHPOD) after transcatheter aortic valve replacement (TAVR). DESIGN Systematic review and meta-analysis. SETTING Elective procedures PARTICIPANTS: Individuals undergoing TAVR. MEASUREMENTS A literature search was conducted in PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials (up to December 2017). All observational studies reporting the incidence of IHPOD after TAVR (sample size > 25) were included in our meta-analysis. The reported incidence rates were weighted to obtain a pooled estimate rate with 95% confidence interval (CI). RESULTS Of 96 potentially relevant articles, 31 with a total of 32,389 individuals who underwent TAVR were included in the meta-analysis. The crude incidence of IHPOD after TAVR ranged from 0% to 44.6% in included studies, with a pooled estimate rate of 8.1% (95% CI=6.7-9.4%); heterogeneity was high (Q = 449; I = 93%; pheterogeneity < .001). The pooled estimate rate of IHPOD was 7.2% (95% CI=5.4-9.1%) after transfemoral (TF) TAVR and 21.4% (95% CI=10.3-32.5%) after non-TF TAVR. CONCLUSION Delirium occurs frequently after TAVR and is more common after non-TF than TF procedures. Recommendations are made with the aim of standardizing future research to reduce heterogeneity between studies on this important healthcare problem. J Am Geriatr Soc 66:2417-2424, 2018.
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Affiliation(s)
- Masieh Abawi
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Matteo Pagnesi
- Interventional Cardiology Unit San Raffaele Scientific Institute, Milan, Italy
| | - Pierfrancesco Agostoni
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Mauro Chiarito
- Cardio Center Humanitas Research Hospital, Rozzano Milan, Italy
| | - Romy C van Jaarsveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Charlotte S van Dongen
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arjen J C Slooter
- Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Antonio Colombo
- Interventional Cardiology Unit San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Nynke H M Kooistra
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pieter A F M Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Azeem Latib
- Interventional Cardiology Unit San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Amofah HA, Broström A, Fridlund B, Bjorvatn B, Haaverstad R, Hufthammer KO, Kuiper KK, Ranhoff AH, Norekvål TM. Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement. Eur J Cardiovasc Nurs 2015; 15:168-77. [PMID: 26635329 PMCID: PMC4804287 DOI: 10.1177/1474515115620992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/15/2015] [Indexed: 12/14/2022]
Abstract
Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase. Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep–wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI. Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep–wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days. Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01). Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep–wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.
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Affiliation(s)
| | - Anders Broström
- Institute of Nursing, Faculty of Health and Social Science, Bergen University College, Norway School of Health Sciences, Jönköping University, Sweden Department of Clinical Neurophysiology, Linkoping University Hospital, Sweden
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Institute of Nursing, Faculty of Health and Social Science, Bergen University College, Norway School of Health Sciences, Jönköping University, Sweden
| | - Bjørn Bjorvatn
- Norwegian Competence Centre for Sleep Disorders, Bergen, Norway Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, University of Bergen, Norway
| | | | - Karel Kj Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Anette Hylen Ranhoff
- Department of Clinical Science, University of Bergen, Norway Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Hospital, Bergen, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Institute of Nursing, Faculty of Health and Social Science, Bergen University College, Norway Department of Clinical Science, University of Bergen, Norway
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