Intraoperative hypotension and delirium among older adults undergoing transcatheter aortic valve replacement. Issue 11 (6th October 2021)

• Record Type: Journal Article
• Authors: Wesselink, Esther M.; Abawi, Masieh; Kooistra, Nynke H. M.; Kappen, Teus H.; Agostoni, Pierfrancesco; Emmelot‐Vonk, Marielle; Pasma, Wietze; van Klei, Wilton A.; van Jaarsveld, Romy C.; van Dongen, Charlotte S.; Doevendans, Pieter A. F. M.; Slooter, Arjen J. C.; Stella, Pieter R.
• Is Part Of: Journal of the American Geriatrics Society. Volume 69:Issue 11(2021)
• Page Start: 3177
• Page End: 3185
• Publication Date: 2021-10-06
• Subjects: delirium -- intraoperative hypotension -- TAVR -- transcatheter aortic valve replacement; Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.17361
• Languages: English
• ISSNs: 0002-8614

Abstract

Abstract: Background: Postoperative delirium (POD) is a frequently observed complication after transcatheter aortic valve replacement (TAVR). The effects of intraoperative hypotension (IOH) on POD occurrence are currently unclear. Methods: A retrospective observational cohort study of patients who underwent TAVR was conducted. We predefined IOH as area under the threshold (AUT) of five mean arterial blood pressures (MBP), varying from <100 to <60 mmHg. The AUT consisted of the combination of duration and depth under the MBP thresholds, expressed in mmHg*min. All MBP AUTs were computed based on the complete procedure, independent of procedural phase or duration. Results: This cohort included 675 patients who underwent TAVR under general anesthesia ( n = 128, 19%) or procedural sedation ( n = 547, 81%). Delirium occurred mostly during the first 2 days after TAVR, and was observed in n = 93 (14%) cases. Furthermore, 674, 672, 663, 630, and 518 patients had at least 1 min intraoperative MBP <100, <90, <80, <70, and <60 mmHg, respectively. Patients who developed POD had higher AUT based on all five MBP thresholds during TAVR. The penalized adjusted odds ratio varied between 1.08 (99% confidence interval [CI] 0.74–1.56) for the AUT based on MBP < 100 mmHg and OR 1.06 (99% CI 0.88–1.28) for the AUT based on MBP < 60 mmHg. Conclusions: Intraoperative hypotension is frequently observed during TAVR, but not independently associated with POD after TAVR. Other potential factors than intraoperative hypotension may explain the occurrence of delirium after TAVR.