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The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement.

Publication ,  Journal Article
Messé, SR; Overbey, JR; Thourani, VH; Moskowitz, AJ; Gelijns, AC; Groh, MA; Mack, MJ; Ailawadi, G; Furie, KL; Southerland, AM; James, ML ...
Published in: J Thorac Cardiovasc Surg
February 2024

OBJECTIVE: The effects of stroke and delirium on postdischarge cognition and patient-centered health outcomes after surgical aortic valve replacement (SAVR) are not well characterized. Here, we assess the impact of postoperative stroke and delirium on these health outcomes in SAVR patients at 90 days. METHODS: Patients (N = 383) undergoing SAVR (41% received concomitant coronary artery bypass graft) enrolled in a randomized trial of embolic protection devices underwent serial neurologic and delirium evaluations at postoperative days 1, 3, and 7 and magnetic resonance imaging at day 7. Outcomes included 90-day functional status, neurocognitive decline from presurgical baseline, and quality of life. RESULTS: By postoperative day 7, 25 (6.6%) patients experienced clinical stroke and 103 (28.5%) manifested delirium. During index hospitalization, time to discharge was longer in patients experiencing stroke (hazard ratio, 0.62; 95% confidence interval [CI], 0.42-0.94; P = .02) and patients experiencing delirium (hazard ratio, 0.68; 95% CI, 0.54-0.86; P = .001). At day 90, patients experiencing stroke were more likely to have a modified Rankin score >2 (odds ratio [OR], 5.9; 95% CI, 1.7-20.1; P = .01), depression (OR, 5.3; 95% CI, 1.6-17.3; P = .006), a lower 12-Item Short Form Survey physical health score (adjusted mean difference -3.3 ± 1.9; P = .08), and neurocognitive decline (OR, 7.8; 95% CI, 2.3-26.4; P = .001). Delirium was associated with depression (OR, 2.2; 95% CI, 0.9-5.3; P = .08), lower 12-Item Short Form Survey physical health (adjusted mean difference -2.3 ± 1.1; P = .03), and neurocognitive decline (OR, 2.2; 95% CI, 1.2-4.0; P = .01). CONCLUSIONS: Stroke and delirium occur more frequently after SAVR than is commonly recognized, and these events are associated with disability, depression, cognitive decline, and poorer quality of life at 90 days postoperatively. These findings support the need for new interventions to reduce these events and improve patient-centered outcomes.

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Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

February 2024

Volume

167

Issue

2

Start / End Page

624 / 633.e4

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Stroke
  • Risk Factors
  • Respiratory System
  • Quality of Life
  • Patient Discharge
  • Humans
  • Heart Valve Prosthesis Implantation
  • Delirium
 

Citation

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Messé, S. R., Overbey, J. R., Thourani, V. H., Moskowitz, A. J., Gelijns, A. C., Groh, M. A., … Cardiothoracic Surgical Trials Network (CTSN) Investigators, . (2024). The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement. J Thorac Cardiovasc Surg, 167(2), 624-633.e4. https://doi.org/10.1016/j.jtcvs.2022.01.053
Messé, Steven R., Jessica R. Overbey, Vinod H. Thourani, Alan J. Moskowitz, Annetine C. Gelijns, Mark A. Groh, Michael J. Mack, et al. “The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement.J Thorac Cardiovasc Surg 167, no. 2 (February 2024): 624-633.e4. https://doi.org/10.1016/j.jtcvs.2022.01.053.
Messé SR, Overbey JR, Thourani VH, Moskowitz AJ, Gelijns AC, Groh MA, et al. The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement. J Thorac Cardiovasc Surg. 2024 Feb;167(2):624-633.e4.
Messé, Steven R., et al. “The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement.J Thorac Cardiovasc Surg, vol. 167, no. 2, Feb. 2024, pp. 624-633.e4. Pubmed, doi:10.1016/j.jtcvs.2022.01.053.
Messé SR, Overbey JR, Thourani VH, Moskowitz AJ, Gelijns AC, Groh MA, Mack MJ, Ailawadi G, Furie KL, Southerland AM, James ML, Moy CS, Gupta L, Voisine P, Perrault LP, Bowdish ME, Gillinov AM, O’Gara PT, Ouzounian M, Whitson BA, Mullen JC, Miller MA, Gammie JS, Pan S, Erus G, Browndyke JN, Cardiothoracic Surgical Trials Network (CTSN) Investigators. The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement. J Thorac Cardiovasc Surg. 2024 Feb;167(2):624-633.e4.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

February 2024

Volume

167

Issue

2

Start / End Page

624 / 633.e4

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Stroke
  • Risk Factors
  • Respiratory System
  • Quality of Life
  • Patient Discharge
  • Humans
  • Heart Valve Prosthesis Implantation
  • Delirium