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

医学谵妄冲程（发动机）危险系数围手术期优势比主动脉瓣置换术内科学置信区间神经认知心脏病学麻醉重症监护医学认知狭窄精神科工程类机械工程

作者

Steven R. Messé,Jessica Overbey,Vinod H. Thourani,Alan J. Moskowitz,Annetine C. Gelijns,Mark A. Groh,Michael J. Mack,Gorav Ailawadi,Karen L. Furie,Andrew M. Southerland,Michael L. James,Claudia S. Moy,Lopa Gupta,Pierre Voisine,Louis P. Perrault,Michael E. Bowdish,A. Marc Gillinov,Patrick T. O’Gara,Maral Ouzounian,Bryan A. Whitson,John C. Mullen,Marissa A. Miller,James S. Gammie,Stephanie Pan,Güray Erus,Jeffrey N. Browndyke,Marissa A. Miller,Wendy C. Taddei‐Peters,Neal Jeffries,Dennis Buxton,Nancy L. Geller,David Gordon,Catherine Burke,Albert Lee,Tyrone Smith,Claudia S. Moy,Ilana Kogan Gombos,Richard D. Weisel,Timothy J. Gardner,Patrick T. O’Gara,Eric A. Rose,Annetine C. Gelijns,Michael K. Parides,Deborah D. Ascheim,Alan J. Moskowitz,Emilia Bagiella,Ellen Moquete,Kinjal Shah,Jessica Overbey,Stephanie Pan,Helena Chang,Melissa Chase,Seth Goldfarb,Lopa Gupta,Katherine Kirkwood,Edlira Dobrev,Ron Levitan,Karen O'Sullivan,Milerva Santos,Xia Ye,Michael J. Mack,Rachelle A. Winkle,Haley Boswell,Amanda Fenlon,Melissa D. Johnson,Jessica Jones,Megan Kolb,Sarah Lam,L. F. Miranda,Jackie Ward,Renessa Whitman,Brittany Zingler,William H. Ryan,Robert L. Smith,Paul Grayburn,Pedro Nosnik,A. Marc Gillinov,Eugene H. Blackstone,Nader Moazami,Randall C. Starling,Benico Barzilai,Richard A. Grimm,Edward G. Soltesz,Irene Katzan,Brian Strippy,Shoi Smith,Michelle Garcia,Mary Alice bowman,Carrie Geither,Robert Wang,Michael Argenziano,Michael A. Borger,Hiroo Takayama,Martin B. Leon,Lyn Goldsmith,Allan Schwartz,Nadia Sookraj,Talaya McCright‐Gill,S. Sreekanth,Jock N. McCullough,Alexander Iribarne,Joseph P. DeSimone,Anthony W. DiScipio,H. P. Stokes,Amanda St. Ivany,Gaylin Petty,Peter K. Smith,John H. Alexander,Carmelo A. Milano,Donald D. Glower,Joel Huber,Joel Morganlander,Joseph P. Mathew,Stacey Welsh,Sarah Casalinova,Victoria Johnson,Kathleen Lane,Derek Smith,Greg Tipton,Mark F. Berry,Judson B. Williams,Brian R. Englum,Matthew G. Hartwig,Vinod H. Thourani,Robert Guyton,Omar M. Lattouf,Edward P. Chen,J. David Vega,Jefferson Baer,Duc Nguyen,Michael E. Halkos,Kim T. Baio,Tamara Prince,Natascha Cook,Alexis A. Neill,Pierre Voisine,Mario Sénéchal,François Dagenais,Robert Laforce,Kim O’Connor,Gladys Dussault,Manon Caouette,Hugo Tremblay,Nathalie Gagné,Julie Dumont,Patricia Landry,Mark A. Groh,Benjamin H. Trichon,Oliver A.R. Binns,Stephen Ely,Alan M. Johnson,Todd H. Hansen,John G. Short,Reid D. Taylor,Ralph Mangusan,Tracy Nanney,Holly Aubart,K. Simon Cross,Leslie McPeters,Christina Riggsbee,Lucy Rixey,Robert E. Michler,Joseph J. DeRose,Daniel J. Goldstein,Ricardo Bello,Cynthia C. Taub,Daniel M. Spevack,Kathryn Kirchoff,Rebecca Meli,Juan García,J.R. Goldenberg,Lauren Kealy,Louis P. Perrault,Denis Bouchard,Jean François Tanguay,Eileen O’Meara,Jonathan Lacharité,Sophie Robichaud,Keith A. Horvath,Philip C. Corcoran,Michael Siegenthaler,Mandy Murphy,Margaret Iraola,Ann Greenberg,Greg Kumkumian,Mark R. Milner,Zurab Nadareishvili,Bryan A. Whitson,Ayesha Hasan,Asia McDavid,Denise Fadorsen,Maral Ouzounian,Terry Yau,Michael E. Farkouh,Anna Woo,Robert J. Cusimano,Tirone E. David,Christopher M. Feindel,Nishit Fumakia,Shakira Christie,John C. Mullen,Asvina Bissonauth,Alexandra Hripko,James S. Gammie,Zahid Noor,Kristen M. Mackowick,Stephanie Deasey,Manal Al-Suqi,Julia Collins,Michael A. Acker,Steven R. Messé,James N. Kirkpatrick,Mary Lou Mayer,Caitlin McDonald,Holley Fok,Breanna Maffei,Stephen Cresse,Christine Gepty,Michael E. Bowdish,Vaughn A. Starnes,David Shavalle,Christi Heck,Amy Hackmann,Craig Baker,Fernando Fleischman,Mark J. Cunningham,Edward Lozano,Michelle L. Hernandez,Gorav Ailawadi,Irving L. Kron,Karen C. Johnston,Ravi K. Ghanta,John Dent,John A. Kern,Leora T. Yarboro,Michael Ragosta,Brian H. Annex,J.A. Bergin,Sandra G. Burks,Mike Cosner,China Green,Samantha Loya,Hye Ryun Kim,David A. Bull,Patrice Desvigne‐Nickens,Dennis O. Dixon,Rebecca F. Gottesman,Mark C. Haigney,Richard Holubkov,Costantino Iadecola,Alice Jacobs,Eric M. Meslin,John M. Murkin,John A. Spertus,Frank W. Sellke,Cheryl L. McDonald,John M. Canty,Neal W. Dickert,Dennis O. Dixon,John S. Ikonomidis,KyungMann Kim,David O. Williams,Clyde W. Yancy,Seemant Chaturvedi,Marc I. Chimowitz,James C. Fang,Wayne Richenbacher,V. Rao,Karen L. Furie,Rachel Miller,Jennifer Cook,David A. D’Alessandro,Frederick T. Han,Sean Pinney,Mary Norine Walsh,David M. Greer,Koto Ishida,Christian Stapf,Judy Hung,Xin Zeng,David Hung,Sudarat Satitthummanid,Michel Billelo,Christos Davatzikos,Güray Erus,Lauren Karpf,Lisa Desiderio,Joseph P. Mathew,Jeffrey N. Browndyke,Michael L. James,Yanne Toulgoat-Dubois,R. Brassard,Renu Virmanu,Maria Romero,Ryan Braumann

出处

期刊：The Journal of Thoracic and Cardiovascular Surgery [American Association for Thoracic Surgery]
日期：2022-03-19 卷期号：167 (2): 624-633.e4 被引量：7

链接

nih.gov nih.govdoi.org

标识

DOI：10.1016/j.jtcvs.2022.01.053

摘要

Abstract

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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