J Korean Med Sci.  2019 Aug;34(31):e205. 10.3346/jkms.2019.34.e205.

Frailty Index is Associated with Adverse Outcomes after Aortic Valve Replacement in Elderly Patients

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea. scalpel@hanmail.net
  • 2Department of Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.

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.

Keyword

Frailty; Elderly; Aortic Stenosis; Aortic Valve Replacement

MeSH Terms

Aged*
Aortic Valve Stenosis
Aortic Valve*
Bioprosthesis
Blood Pressure
Follow-Up Studies
Freedom
Heart Rate
Humans
Logistic Models
Mortality
Proportional Hazards Models
Stents
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