Masieh Abawi1, Matteo Pagnesi2, Pierfrancesco Agostoni1,3, Mauro Chiarito4, Romy C van Jaarsveld1, Charlotte S van Dongen1, Arjen J C Slooter5, Antonio Colombo2,6, Nynke H M Kooistra1, Pieter A F M Doevendans1,7, Azeem Latib2,6, Pieter R Stella1. 1. Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 2. Interventional Cardiology Unit San Raffaele Scientific Institute, Milan, Italy. 3. Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. 4. Cardio Center Humanitas Research Hospital, Rozzano Milan, Italy. 5. Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 6. Interventional Cardiology Unit EMO-GVM Centro Cuore Columbus, Milan, Italy. 7. Netherlands Heart Institute, Utrecht, The Netherlands.
Abstract
OBJECTIVES: To evaluate the incidence of in-hospital postoperative delirium (IHPOD) after transcatheter aortic valve replacement (TAVR). DESIGN: Systematic review and meta-analysis. SETTING: Elective procedures PARTICIPANTS: Individuals undergoing TAVR. MEASUREMENTS: A literature search was conducted in PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials (up to December 2017). All observational studies reporting the incidence of IHPOD after TAVR (sample size > 25) were included in our meta-analysis. The reported incidence rates were weighted to obtain a pooled estimate rate with 95% confidence interval (CI). RESULTS: Of 96 potentially relevant articles, 31 with a total of 32,389 individuals who underwent TAVR were included in the meta-analysis. The crude incidence of IHPOD after TAVR ranged from 0% to 44.6% in included studies, with a pooled estimate rate of 8.1% (95% CI=6.7-9.4%); heterogeneity was high (Q = 449; I = 93%; pheterogeneity < .001). The pooled estimate rate of IHPOD was 7.2% (95% CI=5.4-9.1%) after transfemoral (TF) TAVR and 21.4% (95% CI=10.3-32.5%) after non-TF TAVR. CONCLUSION: Delirium occurs frequently after TAVR and is more common after non-TF than TF procedures. Recommendations are made with the aim of standardizing future research to reduce heterogeneity between studies on this important healthcare problem. J Am Geriatr Soc 66:2417-2424, 2018.
OBJECTIVES: To evaluate the incidence of in-hospital postoperative delirium (IHPOD) after transcatheter aortic valve replacement (TAVR). DESIGN: Systematic review and meta-analysis. SETTING: Elective procedures PARTICIPANTS: Individuals undergoing TAVR. MEASUREMENTS: A literature search was conducted in PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials (up to December 2017). All observational studies reporting the incidence of IHPOD after TAVR (sample size > 25) were included in our meta-analysis. The reported incidence rates were weighted to obtain a pooled estimate rate with 95% confidence interval (CI). RESULTS: Of 96 potentially relevant articles, 31 with a total of 32,389 individuals who underwent TAVR were included in the meta-analysis. The crude incidence of IHPOD after TAVR ranged from 0% to 44.6% in included studies, with a pooled estimate rate of 8.1% (95% CI=6.7-9.4%); heterogeneity was high (Q = 449; I = 93%; pheterogeneity < .001). The pooled estimate rate of IHPOD was 7.2% (95% CI=5.4-9.1%) after transfemoral (TF) TAVR and 21.4% (95% CI=10.3-32.5%) after non-TF TAVR. CONCLUSION: Delirium occurs frequently after TAVR and is more common after non-TF than TF procedures. Recommendations are made with the aim of standardizing future research to reduce heterogeneity between studies on this important healthcare problem. J Am Geriatr Soc 66:2417-2424, 2018.
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