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A Novel Familial Cardiac Arrhythmia Syndrome with Widespread ST-Segment Depression 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Variation in Revascularization Practice and Outcomes in Asymptomatic Stable Ischemic Heart Disease Coronary flow velocity reserve predicts adverse prognosis in women with angina and noobstructive coronary artery disease: resultsfrom the iPOWER study Impact of Coronary Lesion Complexity in Percutaneous Coronary Intervention: One-Year Outcomes From the Large, Multicentre e-Ultimaster Registry Mortality 10 Years After Percutaneous or Surgical Revascularization in Patients With Total Coronary Artery Occlusions Generalizing Intensive Blood Pressure Treatment to Adults With Diabetes Mellitus The spectrum of chronic coronary syndromes: genetics, imaging, and management after PCI and CABG Prevalence of Angina Among Primary Care Patients With Coronary Artery Disease Systems of Care for ST-Segment–Elevation Myocardial Infarction: A Policy Statement From the American Heart Association

Review Article2020 Nov, 13 (21) 2453–2466

JOURNAL:J Am Coll Cardiol. Article Link

Delirium After TAVR: Crosspassing the Limit of Resilience

Kvan der Wulp , MH van Wely , MJP Rooijakkers et al. Keywords: delirium; post TAVR

ABSTRACT

Patients who undergo transcatheter aortic valve replacement often are frail and elderly. Delirium is a frequently observed complication, associated with impaired recovery, prolonged hospital stay, and mortality. In different hospital settings, interventions that reduced the incidence of delirium resulted in improved clinical outcome and reduced costs. In that context, prevention, early recognition, and timely interventions could be the next step toward better outcomes of transcatheter aortic valve replacement. This review is focused on awareness and recognition of delirium, including predisposing “vulnerability” factors (such as cognitive impairment and carotid artery disease) and “trigger” factors (such as anesthesia, hemodynamic imbalance, and complications). For prevention and treatment, clinicians should focus on sleep hygiene, orientation, pain management, and early mobilization. In case of delirium, a thorough search and treatment of trigger factors is warranted. Future studies should focus on risk assessment, preventive and therapeutic interventions, and their potential benefit in terms of costs and clinical outcomes.