Intraoperative hypotension and delirium among older adults undergoing transcatheter aortic valve replacement

Esther M Wesselink, Masieh Abawi, Nynke H M Kooistra, Teus H Kappen, Pierfrancesco Agostoni, Marielle Emmelot-Vonk, Wietze Pasma, Wilton A van Klei, Romy C van Jaarsveld, Charlotte S van Dongen, Pieter A F M Doevendans, Arjen J C Slooter, Pieter R Stella

Onderzoeksoutput: Articlepeer review

6 Citaten (Scopus)

Samenvatting

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.

Originele taal-2English
Pagina's (van-tot)3177-3185
Aantal pagina's9
TijdschriftJournal of the American Geriatrics Society
Volume69
Nummer van het tijdschrift11
DOI's
StatusPublished - nov 2021

Bibliografische nota

© 2021 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.

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