Periinterventional inflammation and blood transfusions predict postprocedural delirium after percutaneous repair of mitral and tricuspid valves

Maria I. Körber; Matthieu Schäfer; Rakave Vimalathasan; Victor Mauri; Christos Iliadis; Clemens Metze; Henrik ten Freyhaus; Volker Rudolph; Stephan Baldus; Roman Pfister

doi:10.1007/s00392-021-01886-z

journal article Open Access Jun 01, 2021

Periinterventional inflammation and blood transfusions predict postprocedural delirium after percutaneous repair of mitral and tricuspid valves

Maria I. Körber Matthieu Schäfer Rakave Vimalathasan Victor Mauri Christos Iliadis

Clemens Metze Henrik ten Freyhaus Volker Rudolph

Stephan Baldus Roman Pfister

Clinical Research in Cardiology Vol. 110 No. 12 pp. 1921-1929 · Springer Science and Business Media LLC

View at Publisher Save 10.1007/s00392-021-01886-z

Abstract

Abstract
Objectives
The aim of this study was to examine predictors and impact of postoperative delirium (POD) on outcome after percutaneous repair of mitral and tricuspid valves.

Background
POD is common in elderly patients and contributes to increased health care costs and worse outcome. Predictors of POD in percutaneous mitral or tricuspid valve procedures are unclear.

Methods
In a prospective single-center study, patients were screened for POD using the Confusion Assessment Method on the first and second postprocedural days, and up until 7 days in patients with clinical suspicion of delirium. Associations of POD with baseline characteristics, periprocedural outcome and mid-term mortality were examined.

Results
One hundred and seventy-seven patients were included (median age 78 years [72–82], 41.8% female) and median (IQR) follow-up was 489 (293–704) days. Patients developing POD (n = 16, 9%) did not differ in baseline and procedural characteristics but more often received postinterventional blood transfusions (37.5% vs. 9.9%, p value = 0.007) and suffered from infections (43.8% vs. 9.9%, p value = 0.001). Patients with POD showed worse survival (HR: 2.71 [1.27–5.78]; p = 0.01), with an estimated 1-year survival of 46 ± 13% compared to 80 ± 3% in patients without POD (log-rank p value 0.007). In multivariate Cox regression, POD remained a significant predictor of mid-term mortality (HR 4.75 [1.97–11.5]; p = 0.001).

Conclusion
After percutaneous mitral or tricuspid valve repair, POD was independently associated with worse mid-term survival. Procedure- rather than patient-associated characteristics such as blood transfusions and infections emerged as important risk factors for development of POD. Considering the substantial prognostic impact of POD, further studies on its prevention are warranted to improve patient outcome.

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Metrics

6

Citations

40

References

Details

Published: Jun 01, 2021
Vol/Issue: 110(12)
Pages: 1921-1929
License: View

Authors

Clinic for Cardiology, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany

Funding

Deutsche Stiftung für Herzforschung Award: F/31/18

Universität zu Köln

Cite This Article

Maria I. Körber, Matthieu Schäfer, Rakave Vimalathasan, et al. (2021). Periinterventional inflammation and blood transfusions predict postprocedural delirium after percutaneous repair of mitral and tricuspid valves. Clinical Research in Cardiology, 110(12), 1921-1929. https://doi.org/10.1007/s00392-021-01886-z

Periinterventional inflammation and blood transfusions predict postprocedural delirium after percutaneous repair of mitral and tricuspid valves

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