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Prognostic Implication of Thermodilution Coronary Flow Reserve in Patients Undergoing Fractional Flow Reserve Measurement Physiologic Characteristics and Clinical Outcomes of Patients With Discordance Between FFR and iFR Gut microbiota induces high platelet response in patients with ST segment elevation myocardial infarction after ticagrelor treatment Evolving understanding of the heterogeneous natural history of individual coronary artery plaques and the role of local endothelial shear stress Relationship between fractional flow reserve value and the amount of subtended myocardium Bosentan therapy in patients with Eisenmenger syndrome: a multicenter, double-blind, randomized, placebo-controlled study Bench testing and coronary artery bifurcations: a consensus document from the European Bifurcation Club Impact of myocardial supply area on the transstenotic hemodynamics as determined by fractional flow reserve Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial Optical coherence tomography and C-reactive protein in risk stratification of acute coronary syndromes

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.