Delirium Among Adults Undergoing Transcatheter Structural Heart Intervention: Incidence, Risk, and Clinical Phenotypes

ABSTRACT Background Delirium is an underrecognized geriatric complication after transcatheter structural heart interventions, with limited descriptive data across procedures and an uncertain association with clinical outcomes. Aims To quantify incidence, identify predictors, and evaluate in‑hospital outcomes of delirium after transcatheter aortic valve replacement (TAVR), transcatheter edge‐to‐edge mitral repair (TEER), transcatheter tricuspid valve replacement/repair (TTVR), and left atrial appendage occlusion (LAAO). Methods Using the National Inpatient Sample, we performed a retrospective analysis of adults undergoing TAVR, TEER, TTVR, or LAAO identified by ICD‑10 codes. Delirium was captured through validated diagnostic codes. Multivariable logistic and linear regression adjusted for demographic, clinical, and in‑hospital covariates to evaluate predictors of delirium and the independent association of delirium with clinical outcomes of interest. Results Among 151,455 weighted hospitalizations (86,940 TAVR, 15,305 TEER, 1250 TTVR, and 47,960 LAAO), delirium occurred in 2.8%, 4.0%, 4.4%, and 0.6% of cases, respectively. Delirium was independently associated with increased in‐hospital mortality across all procedures (TAVR: aOR 4.5, 95% CI 2.9–6.9; TEER: aOR 2.7, 95% CI 1.1–6.6; TTVR: aOR 27.7, 95% CI 5.6–137.3; LAAO: aOR 24.5, 95% CI 5.4–110.8). Patients with delirium also had higher rates of mechanical ventilation and cardiac arrest, longer length of stay, and greater hospitalization costs. Geriatric‐specific conditions, including frailty, dementia, malnutrition, and high comorbidity burden, were among the strongest predictors of delirium. Conclusions Delirium after transcatheter structural heart interventions is strongly associated with adverse clinical outcomes and greater resource utilization. These findings underscore the importance of incorporating delirium risk stratification and targeted prevention strategies into structural heart pathways to preserve the net clinical benefit of these interventions.