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Updated: Sep 11, 2025

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Association of cognitive impairment with utilization and acute outcomes of aortic valve replacement
Konmal Ali1, Amulya Vadlakonda1, Sara Sakowitz1
1Cardiovascular Outcomes Research Laboratories (CORELAB), Department of Surgery, University of California, Los Angeles, CA.
Background:
An increasing number of older adults are diagnosed with severe aortic stenosis and offered surgical or transcatheter aortic valve replacement. Given that the increase in cognitive impairment among geriatric patients has been estimated up to approximately 30%, we examined the independent association of cognitive impairment with postoperative outcomes.
Methods:
All hospitalizations involving surgical aortic valve replacement or transcatheter aortic valve replacement for aortic stenosis among older adults (≥65 years) were identified from the 2016-2021 Nationwide Readmissions Database. Patients were stratified based on preoperative cognitive impairment or dementia into cognitive impairment or dementia and no-cognitive impairment or dementia cohorts. Multivariable regression models were fit to evaluate the association of cognitive impairment or dementia with outcomes of interest.
Results:
Of approximately 505,356 patients undergoing aortic valve replacement, 16,704 (3.3%) had cognitive impairment. On average, the cognitive impairment or dementia cohort was older (83 [78-87] vs 78 [72-84] years, P < .001) but of clinically similar Elixhauser scores (5 [4-6] vs 5 [4-6], P = .07). The cognitive impairment or dementia cohort more frequently received transcatheter aortic valve replacement (87.2% vs 70.0%, P < .001). Among patients receiving transcatheter aortic valve replacement, cognitive impairment or dementia was associated with greater odds of cardiac (adjusted odds ratio: 1.25, confidence interval: 1.16-1.40), respiratory (adjusted odds ratio: 1.37, confidence interval: 1.20-1.56), and infectious complications (adjusted odds ratio: 1.41, confidence interval: 1.25-1.58). Similar results persisted among the surgical aortic valve replacement cohort. Further, among both surgical aortic valve replacement and transcatheter aortic valve replacement recipients, cognitive impairment or dementia was linked to greater hospitalization costs, nonhome discharge, and 30-day nonelective readmission.
Conclusion:
Preoperative cognitive impairment was linked with greater likelihood of transcatheter aortic valve replacement, but inferior clinical and financial endpoints, relative to others. Future work should consider the factors that contribute to greater morbidity among this group and develop appropriate in- and out-of-hospital interventions.
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