Frailty Index is Associated with Adverse Outcomes after Aortic Valve Replacement in Elderly Patients
10.3346/jkms.2019.34.e205
- Author:
Bongyeon SOHN
1
;
Jae Woong CHOI
;
Ho Young HWANG
;
Myoung jin JANG
;
Kyung Hwan KIM
;
Ki Bong KIM
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea. scalpel@hanmail.net
- Publication Type:Original Article
- Keywords:
Frailty;
Elderly;
Aortic Stenosis;
Aortic Valve Replacement
- MeSH:
Aged;
Aortic Valve Stenosis;
Aortic Valve;
Bioprosthesis;
Blood Pressure;
Follow-Up Studies;
Freedom;
Heart Rate;
Humans;
Logistic Models;
Mortality;
Proportional Hazards Models;
Stents
- From:Journal of Korean Medical Science
2019;34(31):e205-
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: This study was conducted to evaluate the prognostic value of the frailty index based on routine laboratory data (FI-L) in elderly patients who underwent surgical aortic valve replacement (SAVR). METHODS: A total of 154 elderly patients (≥ 75 years) (78.7 ± 3.6 years; men:women = 78:76) who underwent aortic valve replacement with stented bioprosthesis between 2001 and 2018 were enrolled. The FI-L was calculated as the proportion of abnormal results out of 32 items based on laboratory tests, pulse rate and blood pressure. The primary outcome was all-cause mortality. Secondary outcomes included operative mortality and aortic valve-related events (AVREs) during follow-up. The predictive values of FI-L for the early and late outcomes were evaluated using logistic regression and Cox proportional hazards models, respectively. The median follow-up duration was 40 months (interquartile, 15–74). RESULTS: The operative mortality rate was 3.9% (n = 6). Late death occurred in 29 patients. The overall survival (OS) rates at 5, 10, and 15 years were 83.3%, 59.0%, and 41.6%, respectively. The AVREs occurred in 28 patients and the freedom rates from AVREs at 5, 10, and 15 years were 79.4%, 72.7%, and 52.9%, respectively. Multivariable analyses demonstrated that FI-L was a significant factor for OS (hazard ratio, 1.075; 95% confidence interval, 1.040–1.111). A minimal P value approach showed that a FI-L of 25% was the best cutoff value to predict OS after SAVR. CONCLUSION: The FI-L is significantly associated with early and long-term outcomes after SAVR in elderly patients. Frailty rather than a patient's age should be considered in the decision-making process for SAVR in elderly patients.
