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Negative Risk Markers for Cardiovascular Events in the Elderly Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis Six-month versus 12-month dual antiplatelet therapy after implantation of drug-eluting stents: the Efficacy of Xience/Promus Versus Cypher to Reduce Late Loss After Stenting (EXCELLENT) randomized, multicenter study 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis Predictors and Clinical Outcomes of Next-Day Discharge After Minimalist Transfemoral Transcatheter Aortic Valve Replacement Colchicine Reduces Cardiovascular Events in Chronic Coronary Disease Prevalence and Outcomes of Concomitant Aortic Stenosis and Cardiac Amyloidosis Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis Online Quantitative Aortographic Assessment of Aortic Regurgitation After TAVR: Results of the OVAL Study

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.