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.