Key result
TAVI is linked to ~65% lower odds of postoperative delirium compared to SAVR.
Why the study?
TAVI and SAVR have different levels of invasiveness that may lead to different postoperative functional status, prompting a direct comparison of postoperative delirium and clinical outcomes between the two procedures.
Does Transcatheter Aortic Valve Implantation (TAVI) reduce the incidence of postoperative delirium compared to Surgical Aortic Valve Replacement (SAVR) in patients undergoing aortic valve replacement?
Meta-Analysis (n=12,015)
Yes
Does Transcatheter Aortic Valve Implantation (TAVI) reduce the incidence of postoperative delirium compared to Surgical Aortic Valve Replacement (SAVR) in patients undergoing aortic valve replacement?
TAVI is associated with a significantly lower odds of postoperative delirium compared to SAVR without significant differences in 30-day mortality, stroke, major bleeding, or hospital length of stay.
Supports TAVI selection in high-delirium-risk patients; extends comparative effectiveness data for aortic valve procedures.
Background: Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) have different levels of invasiveness which can result in different levels of functional status after the procedure. Methods: We performed a systematic review and meta-analysis to detect studies showing direct comparison between TAVI and SAVR regarding postoperative functional status. The primary endpoint was the incidence of postoperative delirium (POD) after TAVI or SAVR, assessed using the Confusion Assessment Method (CAM). Secondary endpoints included 30-day mortality, stroke, major bleeding, and hospital length of stay (LOS). Results: We identified 1,161 manuscripts, of which 10 studies (12,015 patients) were analyzed. TAVI patients had a significantly lower incidence of POD (OR: 0.35, 95 % CI, 0.26-0.48, p < 0.01) compared to SAVR patients. No significant differences were found in secondary outcomes between the groups. Conclusions: TAVI is associated with a lower incidence of postoperative delirium compared to SAVR without compromising length of stay or other major clinical outcomes. Further research is needed to understand the impact of postoperative delirium on short and long-term outcomes.
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Runkel et al. (2024) conducted a meta-analysis in Aortic valve disease undergoing aortic valve replacement (TAVI or SAVR) (n=12,015). Transcatheter Aortic Valve Implantation (TAVI) vs. Surgical Aortic Valve Replacement (SAVR) was evaluated on Incidence of postoperative delirium (POD) assessed using the Confusion Assessment Method (CAM) (OR 0.35, 95% CI 0.26-0.48, p=<0.0001). Transcatheter aortic valve implantation (TAVI) was associated with a significantly lower incidence of postoperative delirium compared to surgical aortic valve replacement (OR 0.35, 95% CI 0.26-0.48, p<0.0001).
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