Mauri Victor, Reuter Kevin, Körber Maria I, Wienemann Hendrik, Lee Samuel, Eghbalzadeh Kaveh, Kuhn Elmar, Baldus Stephan, Kelm Malte, Nickenig Georg, Veulemans Verena, Jansen Felix, Adam Matti, Rudolph Tanja K
Department of Cardiology, Faculty of Medicine, Heart Center, University of Cologne, Cologne, Germany.
Department of Cardiothoracic Surgery, Faculty of Medicine, Heart Centre, University of Cologne, Cologne, Germany.
Front Cardiovasc Med. 2021 Mar 26;8:645724. doi: 10.3389/fcvm.2021.645724. eCollection 2021.
The aim of the present study was to analyze incidence, risk factors, and association with long-term outcome of postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR). Six hundred and sixty one consecutive patients undergoing TAVR were prospectively enrolled from January 2016 to December 2017. POD was assessed regularly during ICU-stay using the CAM-ICU test. The incidence of POD was 10.0% ( = 66). Patients developing POD were predominantly male (65%), had higher EuroSCORE II (5.4% vs. 3.9%; = 0.041) and were more often considered frail (70% vs. 26%; < 0.001). POD was associated with more peri-procedural complications including vascular complications (19.7 vs. 9.4; = 0.017), bleeding (12.1 vs. 5.4%; = 0.0495); stroke (4.5 vs. 0.7%; = 0.025), respiratory failure requiring ventilation (16.7% vs. 1.8%; < 0.001), and pneumonia (34.8% vs. 7.1%; < 0.001). Consequently, patients with POD had significantly longer ICU- (7.9 vs. 3.2 days < 0.001) and hospital-stay (14.9 vs. 9.0 days; < 0.001), and higher in-hospital mortality (6.1 vs. 2.1%; = 0.017). Logistic regression analysis identified male sex (odds ratio (OR) 2.2 [95% confidence interval (CI) 1.2-4.0); = 0.012], atrial fibrillation [OR 3.0 (CI 1.6-5.6); < 0.001], frailty [OR 4.3 (CI 2.4-7.9); < 0.001], pneumonia [OR 4.4 (CI 2.3-8.7); < 0.001], stroke [OR 7.0 (CI 1.2-41.6); = 0.031], vascular complication [OR 2.9 (CI 1.3-6.3); = 0.007], and general anesthesia [OR 2.0 (CI 1.0-3.7); = 0.039] as independent predictors of POD. On Cox proportional hazard analysis POD emerged as a significant predictor of 2-year mortality [HR 1.89 (CI 1.06-3.36); = 0.030]. POD is a frequent finding after TAVR and is significantly associated with reduced 2-year survival. Predictors of delirium include not only peri-procedural parameters like stroke, pneumonia, vascular complications and general anesthesia but also baseline characteristics as male sex, atrial fibrillation and frailty.
本研究的目的是分析经导管主动脉瓣置换术（TAVR）后术后谵妄（POD）的发生率、危险因素及其与长期预后的关系。2016年1月至2017年12月，前瞻性纳入了661例连续接受TAVR的患者。在重症监护病房（ICU）住院期间，使用CAM-ICU测试定期评估POD。POD的发生率为10.0%（n = 66）。发生POD的患者以男性为主（65%），欧洲心脏手术风险评估系统（EuroSCORE）II评分较高（5.4%对3.9%；P = 0.041），且更常被认为身体虚弱（70%对26%；P < 0.001）。POD与更多围手术期并发症相关，包括血管并发症（19.7%对9.4%；P = 0.017）、出血（12.1%对5.4%；P = 0.0495）、中风（4.5%对0.7%；P = 0.025）、需要机械通气的呼吸衰竭（16.7%对1.8%；P < 0.001）和肺炎（34.8%对7.1%；P < 0.001）。因此，发生POD的患者ICU住院时间显著延长（7.9天对3.2天；P < 0.001），住院时间也显著延长（14.9天对9.0天；P < 0.001），且院内死亡率更高（6.1%对2.1%；P = 0.017）。逻辑回归分析确定男性（比值比[OR] 2.2 [95%置信区间（CI）1.2 - 4.0]；P = 0.012）、心房颤动[OR 3.0（CI 1.6 - 5.6）；P < 0.001]、身体虚弱[OR 4.3（CI 2.4 - 7.9）；P < 0.001]、肺炎[OR 4.4（CI 2.3 - 8.7）；P < 0.001]、中风[OR 7.0（CI 1.2 - 41.6）；P = 0.031]、血管并发症[OR 2.9（CI 1.3 - 6.3）；P =
