Scripties UMCG - Rijksuniversiteit Groningen
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Delier na Transkatheter Aortaklep vervanging in de oudere patiënt

(2017) Loonstra, Y. (Yvette)

Introduction Aortic valve stenosis is a common disease of the heart valve in adults, off which
the prevalence increases with age. The treatment of choice in severe aortic stenosis is surgical
aortic valve replacement (AVR). However, the burden of this treatment is too high for most
aging patients. Since 2002 these vulnerable patients have the possibility to undergo
transcatheter aortic valve implantation (TAVI). Delirium is a frequently seen complication
after TAVI, with an incidence of 29%. Unfortunately, there is yet no consensus, on the
possible predictors of a delirium after a TAVI. Recently it has been shown, that patients aged
≥ 80 years, who suffered from delirium after TAVI, have a short term (1 month) decline in
Activities of Daily Living (ADL)-independence. Nevertheless, long term (6 months) effect
have not been observed. The effect of delirium on ADL-independence and instrumental ADL
(iADL)-independence in patients aged under 80 is still unknown.
Aim The aim of this study, was to investigate the association between the development of a
delirium after TAVI and long term (i)ADL-independence. Furthermore, we aimed to identify
predictors for developing a delirium after TAVI. The line of research, where this study is part
of, has the ultimate goal to improve decision-making in the TAVI procedure.
Method Fifty-seven consecutive patients who underwent TAVI were included. Patients in this
cohort were considered elderly and to have a great a risk for complications and mortality in
conventional open-heart surgery. (i)ADL-functioning was examined before TAVI and 6-12
months after TAVI. Univariate logistic regression analysis was used to identify predictors for
delirium after TAVI. Differences in (i)ADL-independence at follow-up were analyzed using
Fisher’s Exact Test.
Results The incidence of delirium was 17,5%. Factors associated with a higher risk at
postoperative delirium were a previous delirium, TAVI via another access route than
transfemoral, higher EuroSCORE, longer stay at the Intensive Care (IC)/Coronary Care Unit
(CCU) and prolonged hospital stay. Of the patients suffering from delirium, 88,9% showed a
decline in (i)ADL-functioning in contrast to 34,9% of the patients who did not suffer from
delirium (P = 0.01).
Conclusion Patients who suffered from postoperative delirium more often showed long-term
decline in (i)ADL-functioning. Therefore it is important to take in account the factors
associated with an increased risk of delirium in decision-making in the TAVI procedure.

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