Abstract 16245: The Impact of Delirium After Trans-catheter Aortic Valve Replacement

Abstract

Introduction: Delirium is associated with increased healthcare utilization, morbidity, and mortality. We assessed the impact of delirium on outcomes after trans-catheter aortic valve replacement (TAVR). Methods: We reviewed 294 consecutive cases of TAVR at a tertiary care academic medical center from June, 2008 to February, 2015. Delirium was identified by prospective confusion assessment method screening and retrospective chart review. The primary outcome was overall survival. Secondary outcomes included length of hospital stay, discharge destination, hospital re-admission within 30 days, and 30 day mortality. Results: Delirium was identified in 61 patients after TAVR (21%). Non-femoral access for TAVR was more common in delirious than non-delirious patients (41% vs 28%, P=0.04). There was no difference in the post-operative stroke rate between delirious and non-delirious patients (8% vs 6%, P=0.45). Post-TAVR respiratory failure was more common in delirious patients (21% vs 3%, P<0.001). Of 13 delirious patients who developed respiratory failure, delirium preceded respiratory failure in 8 (62%). Median follow-up was 8.2 months. Delirious patients had decreased overall survival compared to non-delirious patients (figure, log-rank P<0.01). After adjusting for Society of Thoracic Surgeons risk score and TAVR access type, delirium remained an independent predictor of overall survival (hazard ratio 1.97, 95% confidence interval 1.18 to 3.23, P<0.01). Delirium was associated with longer mean length of hospital stay (13.3 +/- 9.5 days vs 6.7 +/- 3.8 days, P<0.001) and higher rates of discharge to a rehabilitation facility (61% vs 27%, P<0.001). There was no difference in 30 day hospital re-admission rates or 30 day mortality between groups. Conclusions: Delirium, a common syndrome after TAVR, is associated with decreased survival and increased healthcare utilization. Early detection of delirium after TAVR may help identify a high risk subset of patients.