Author + information
- Anezi Uzendu, 35211,
- Amy Knight,
- Massoud Leesar,
- Satinder Singh,
- Lindsay Jernigan,
- James Davies,
- Mark Sasse,
- Julian Booker and
- Oluseun Alli
Dementia affects fourteen percent of the elderly, and its prevalence is increasing as the general population ages. Dementia has been associated with poor outcomes in patients undergoing elective cardiac surgery. It is unclear if this holds true for patients undergoing a less invasive transcatheter aortic valve replacement (TAVR), for the treatment of severe aortic stenosis. However, in clinical practice patients have at times been excluded from therapy based on this assumption.
To determine the impact of dementia on patient outcomes following transcatheter aortic valve replacement. Hypothesis Patients with dementia will have worse thirty day outcomes than patients without dementia.
Selected patients undergoing TAVR were prospectively enrolled into a registry that assessed cognitive impairment prior to TAVR. This assessment was made using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), a brief widely used neuropsychological instrument shown to have good test-retest reliability and convergent validity. The primary outcomes assessed were 30-day all-cause mortality, acute coronary syndrome and stroke. The secondary outcomes assessed were length of stay, ICU hours, and thirty-day readmission rate.
In all, 98 patients undergoing TAVR were prospectively enrolled into this registry. Patients with severe memory impairment on the RBANS (scaled score less than 60) were found to have a longer length of stay in hospital, 5.2 days vs 4.0 days (p= 0.042), longer ICU length of stay, 45.0 hours vs 30.2 hours (p=0.023), and increased 30 day readmission rate, odds ratio of 2.08 (p=0.177), when compared to those with less cognitive impairment. There was not enough statistical power to detect significant differences in 30-day all cause mortality, cardiac and neurological events.
Advanced dementia is associated with increased length of ICU and hospital stay. However, the clinical significance is marginal and should not preclude the patients from therapy based on our results. Larger studies will need to be performed to assess the primary outcomes that could not be addressed in this study.