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Journal of the American Geriatrics Society
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Journal of the American Geriatrics Society
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Intraoperative hypotension and delirium among older adults undergoing transcatheter aortic valve replacement

Authors: Esther M. Wesselink; Masieh Abawi; Nynke H. M. Kooistra; Teus H. Kappen; Pierfrancesco Agostoni; Marielle Emmelot‐Vonk; Wietze Pasma; +6 Authors

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

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.

Keywords

Male, Regular Issue Content, TAVR, Anesthesia, General, Postoperative Complications/chemically induced, Transcatheter Aortic Valve Replacement, delirium, Postoperative Complications, Risk Factors, risk factors, Humans, Intraoperative Complications, Hypotension/etiology, Netherlands, Retrospective Studies, Aged, 80 and over, intraoperative hypotension, Intraoperative Complications/chemically induced, Delirium, Delirium/epidemiology, Treatment Outcome, Anesthesia, General/adverse effects, Transcatheter Aortic Valve Replacement/adverse effects, transcatheter aortic valve replacement, Female, Geriatrics and Gerontology, Hypotension, aged, 80 and over

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    influence
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    impulse
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
16
Top 10%
Average
Top 10%
Green
hybrid