Delirium is associated with higher mortality in transcatheter aortic valve replacement: systemic review and meta-analysis

Abstract

Post-operative delirium (POD) has been recognized as an independent risk factor for mortality. Recent studies suggest that POD is associated with higher mortality rates in patients undergoing transcatheter aortic valve replacement (TAVR). However, a systematic review and meta-analysis of the literature has not been performed. This study assessed the association between POD and TAVR by performing a systematic review and meta-analysis of the literature. We comprehensively searched the databases of MEDLINE and EMBASE from inception to April 2018. Included studies were prospective or retrospective cohort studies that compared mortality among patients undergoing TAVR both with and without POD. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Seven studies consisting of 20,086 subjects undergoing TAVR (1517 with POD and 18,569 without POD) were included in this meta-analysis. POD demonstrated a trend towards higher all-cause mortality (pooled odd ratio 1.52, 95% confidence interval 0.98-2.37, p = 0.062, I² = 72%). POD was associated with a significant increased long-term mortality (pooled odd ratio 2.11, 95% confidence interval 1.21-3.68, p = 0.009, I² = 62.5%). POD was associated with an increased risk of long-term all-cause mortality in patients undergoing TAVR. Our study suggests POD could be a potential risk factor of mortality among patients undergoing TAVR. Further studies implementing preventative and treatment strategies against delirium and its effect on POD and its associated mortality are needed.

Keywords: Delirium; Meta-analysis; Mortality; Systematic reviews; Transcatheter aortic valve replacement.