The Impact of Cognitive Impairment on Clinical Outcomes After Transcatheter Aortic Valve Implantation (from a Systematic Review and Meta-Analysis)

• Published in: The American journal of cardiology Vol. 185; pp. 63 - 70
• Main Authors: Sim, Jackie Jia Lin, Ling, Ryan Ruiyang, Neo, Vernicia Shu Qi, Tan, Felicia Liying, Djohan, Andie Hartanto, Yeo, Leonard L.L., Chan, Keith Andrew, Lim, Yinghao, Tan, Benjamin Y.Q., Yeo, Tiong-Cheng, Chan, Mark Y., Poh, Kian-Keong, Kong, William K.F., Yip, James W.L., Chong, Yao Feng, Sharma, Vijay K., Kuntjoro, Ivandito, Sia, Ching-Hui
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 15.12.2022; Elsevier Limited
• Subjects: Activities of daily living; Alzheimer's disease; Aorta; Aortic valve; Bias; Chi-square test; Clinical outcomes; Clinical trials; Cognitive ability; Cohort analysis; Delirium; Dementia; Hazards; Heart valves; Impairment; Implantation; Meta-analysis; Mortality; Patients; Risk analysis; Risk factors; Sensitivity analysis; Systematic review; Thoracic surgery; Transplants & implants
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2022.09.010

This study sought to investigate the impact of pre-existing cognitive impairment on outcomes after transcatheter aortic valve implantation (TAVI). TAVI has been increasingly used in seniors, and evidence suggests better outcomes than surgical aortic valve replacement. Although frailty has been shown to be associated with poorer outcomes after TAVI, the effect of pre-existing cognitive impairment on patient outcomes after TAVI remains unclear. We searched the Medline, Embase, Scopus and Cochrane databases until May 14, 2022. The risk of bias was assessed using the Newcastle-Ottawa scale. The primary outcome was short-term (6 months to 1 year) mortality, and secondary outcomes included long-term (1 year to 3 years) mortality, in-hospital mortality, and postoperative delirium. A total of 14 studies with 32,746 patients (5,098 patients with cognitive impairment at baseline, 27,648 without) were included in our meta-analysis. Among studies that reported the raw proportion of patients with mortality of postoperative delirium, cognitive impairment significantly increased mortality (risk ratio 2.10, 95% confidence intervals [CIs] 1.43 to 3.08, p = 0.0002) and postoperative delirium (risk ratio 2.27, 95% CI 1.76 to 2.93, p <0.0001). Studies which reported the hazards for mortality (pooled hazards ratio 1.97, 95% CI 1.50 to 2.60, p <0.0001) and odds of postoperative delirium (pooled odds ratio 2.40, 95% CI: 1.51 to 3.80, p = 0.0002) yielded results consistent with the primary meta-analysis. In conclusion, pre-existing cognitive impairment is a significant risk factor for poorer outcomes after TAVI and should be carefully considered in this group of patients. Guidelines and future studies should take cognitive impairment into consideration for preoperative risk stratification.