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Updated: Mar 3, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Delirium After Transcatheter Aortic Valve Replacement: Incidence, Predictive Factors, and 1-Year Functional and
Gabriele Melegari1, Michele Villa2, Martino Regazzi3
1Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Italy.
Objectives:
To determine the incidence of postoperative delirium (POD) following transcatheter aortic valve replacement (TAVR), identify predisposing risk factors, and evaluate its impact on cognitive and functional outcomes at 3 months and 1 year.
Design:
Prospective observational cohort study.
Setting:
A single-center tertiary university hospital.
Participants:
A total of 201 elderly patients underwent TAVR via transfemoral or alternative access routes.
Interventions:
All patients underwent standardized perioperative care. Delirium screening was performed using the Confusion Assessment Method (CAM)/CAM for the intensive care unit for 5 days postoperatively and confirmed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Baseline cognitive and functional status were assessed using the Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), and Barthel Index.
Measurements And Main Results:
The incidence of POD was 21.9%. Multivariate logistic regression identified lower baseline MMSE (odds ratio [OR], 0.81; 95% CI, 0.70-0.94), elevated white blood cell count (OR 1.19; 95% CI, 1.01-1.41), and nontransfemoral access (OR 3.09; 95% CI, 1.36-7.02) as independent predictors of POD. POD was associated with prolonged hospital stays, impaired functional recovery at follow-up (lower Barthel Index), and increased 1-year mortality (hazard ratio, 2.73; p = 0.03). No significant differences were observed in MMSE evolution over time, indicating a likely preexisting cognitive vulnerability.
Conclusions:
POD is a serious complication after TAVR, particularly in patients with cognitive impairments or those undergoing nontransfemoral access. Preoperative cognitive assessments can help identify high-risk individuals. POD is associated with decreased functional recovery and increased 1-year mortality, highlighting the need for targeted prevention strategies for this vulnerable group.
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