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

Tijdschriftbijdrage - Tijdschriftartikel

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.

Tijdschrift: J Am Geriatrics Soc
ISSN: 0002-8614
Issue: 11
Volume: 69
Pagina's: 3177-3185
Jaar van publicatie:2021
Trefwoorden:Aged, 80 and over, Anesthesia, General/adverse effects, Delirium/epidemiology, Female, Humans, Hypotension/etiology, Intraoperative Complications/chemically induced, Male, Netherlands, Postoperative Complications/chemically induced, Retrospective Studies, Risk Factors, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome, Leeftijds- en gender-gerelateerde geneeskunde
Toegankelijkheid:Open