The impact of frailty in aortic valve surgery
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RESEARCH ARTICLE
Open Access
The impact of frailty in aortic valve surgery Elisabet Berastegui Garcia1*, Maria Luisa Camara Rosell1, Enrique Moret Ruiz2, Irma Casas Garcia3, Sara Badia Gamarra1, Claudio Fernandez Gallego1, Luis Delgado Ramis1, Ignasi Julia Almill1, Anna Llorens Ferrer1, Bernat Romero Ferrer1, Antoni Bayes Genis4 and Christian Muñoz Guijosa1
Abstract Background: Frailty is a geriatric syndrome that diminishes potential functional recovery after any surgical procedure. Preoperative surgical risk assessment is crucial to calibrate the risk and benefit of cardiac surgery. The aim of this study was to test usefulness of FRAIL Scale and other surgical-risk-scales and individual features of frailty in cardiac aortic valve surgery. Methods: Prospective study. From May-2014 to February-2016, we collected 200 patients who underwent aortic valve replacement, either surgically or transcatheter. At 1-year follow-up, quality of life measurements were recorded using the EQ-5D (EuroQol). Univariate and multivariate analyses correlated preoperative condition, features of frailty and predicted risk scores with mortality, morbidity and quality of life at 1 year of follow-up. Results: Mean age 78.2y, 56%male. Mean-preoperative-scores: FRAIL scale 1.5(SD 1.02), STS 2.9(SD 1.13), BI 93.8(SD 7.3), ESlog I 12.8(SD 8.5) and GS 7.3 s (SD 1.9). Morbidity at discharge, 6 m and 1 year was 51, 14 and 28%. Mortality 4%. Survival at 6 m/ 1-y was 97% / 88%. Complication-rate was higher in TAVI group due to-vascular complications. Renal dysfunction, anemia, social dependence and GS slower than 7 s were associated with morbidity. On multivariate analysis adjusted STS, BI and GS speed were statistically significant. Quality of life at 1-year follow-up adjusted for age and prosthesis type showed a significant association with STS and FRAIL scale scores. Conclusions: Frailty increases surgical risk and is associated with higher morbidity. Preoperative GS slower 7 s, and STS and FRAIL scale scores seem to be reliable predictors of quality of life at 1-year follow-up. Keywords: Aortic valve replacement, Frailty, Risk scales
Background Aortic stenosis (AS) is one of the most common valvular diseases in developed countries. AS is closely associated with age and its prevalence is now estimated at 12% in patients older than 75 years [1–3]. Symptomatic AS, if untreated, carries a poor prognosis [2, 3]. Medical treatment is ineffective and aortic valve replacement (AVR) is still the gold standard treatment for this condition. According to the Spanish Cardiac Surgery Association Registry [4], AVR represents 42.5% of all surgical activity * Correspondence: [email protected] 1 Cardiac Surgery Department, Hospital Universitari Germans Trias i Pujol, Crtra Canyet s/n, 08914 Badalona, Spain Full list of author information is available at the end of the article
on an isolated valve. Currently, 45% of aortic prostheses implanted in Spain are bioprostheses due to an aging population and to avoid the increased comorbidity associat
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