Predictors of Delirium with Agitation After Aortic Valve Replacement and Its Long-Term Consequences: An Observational File Study

Background: Postoperative delirium (POD) is commonly observed after surgical aortic valve replacement (SAVR) and could have serious consequences. Its prevalence varied among prior published series. With increasing patient age, a worsening of this problem can be expected. Methods: The association between POD and other adverse events, as well as its effect on 30-day mortality, long-term survival, and later dementia development, was investigated in 1500 consecutive patients (1527 operations) undergoing SAVR with a biological prosthesis, with or without concomitant procedures. An observational retrospective file analysis was performed, using chi-square, Student’s t-test, logistic regression, and Kaplan–Meyer analyses. Results: POD was recorded in 183/1527 (12.0%) of the patient files. Its independent predictors were need for reintervention, age over 80 years, male gender, peripheral artery disease, smoking, need for non-elective SAVR, atrial fibrillation, and a prior TIA. POD was associated with all other postoperative adverse events and increased need for resources. Thirty-day mortality was almost four times higher with POD: 35/182 (19.1%) vs. 59/1345 (4.4%), p < 0.001. Five-year survival was significantly reduced in patients with POD: 79.8 ± 1.2% versus 59.5 ± 4.3%, p < 0.001. The mean time to occurrence of dementia was 89 (84–95) months in patients without POD versus 60 (50–71) months in patients with POD. Five-year freedom from dementia was 69.1 ± 2.9% versus 44.4 ± 6.8%, p < 0.001. Conclusions: POD is associated with short-term complication rates, increased need for resources and hospital mortality, a reduced long-term survival rate, and an increased risk of dementia development. The limitations of this investigation include its retrospective and observational nature; in addition, it did not detect preoperative mild cognitive impairment.