Perioperative management after transcatheter aortic valve replacement and postoperative delirium assessment: a nationwide Italian survey.

BACKGROUND

Patients undergoing Transcatheter Aortic Valve Replacement (TAVR) are at risk for delirium. In Italy, the perioperative management of TAVR lacks standardization: this survey aims to investigate TAVR management across the country, focusing on delirium.

METHODS

A multiple-choice survey was conducted anonymously among 40 high-volume cardiac surgery centers in Italy: questions addressed logistics, surgical procedures, anesthetic management and delirium assessment.

RESULTS

The response rate was 68%. Low-volume centers were excluded, resulting in a final sample of 22 hospitals, including 7 of the top 10 highest-volume TAVR centers in Italy. Only 36% of the participating centers routinely assessed delirium onset after TAVR, and just 18% utilized a validated delirium diagnostic scale. Only one-third of the hospitals systematically assessed patient frailty in the preoperative period. Fast-track protocols for TAVR patients were implemented in 68% of the centers. The transfemoral approach was consistently the first choice, with conscious sedation being the preferred anesthetic strategy (82%). Invasive blood pressure monitoring with a dedicated line was routinely performed in 91% of centers, while urinary catheters were used in half of the hospitals, including 47% of those with fast-track protocols. Postoperatively, 55% of patients were admitted to a Subacute or Coronary Care Unit, while 41% were managed in the Cardiology ward. In most cases, the hospital length of stay was three days or more.

CONCLUSIONS

This survey reveals substantial heterogeneity in perioperative management, delirium prevention and assessment after TAVR in Italy. This heterogeneity may contribute to differences in hospital stay and clinical outcomes.