Frailty, disability and comorbidity: different domains lead to different effects after surgical aortic valve replacement in elderly patients
Identificadores
Identificadores
URI: http://hdl.handle.net/20.500.11940/15707
PMID: 31220291
DOI: 10.1093/icvts/ivz093
ISSN: 1569-9293
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Fecha de publicación
2019Título de revista
Interact Cardiovasc Thorac Surg
Tipo de contenido
Artigo
DeCS
estado de salud | prótesis valvulares cardíacas | resultado del tratamiento | anciano | tasa de supervivencia | estimación de Kaplan-Meier | factores de riesgo | estudios prospectivos | evaluación de riesgos | humanos | estenosis de la válvula aórtica | evaluación geriátricaMeSH
Risk Factors | Risk Assessment | Aortic Valve Stenosis | Humans | Heart Valve Prosthesis | Treatment Outcome | Health Status | Prospective Studies | Kaplan-Meier Estimate | Geriatric Assessment | Survival Rate | AgedResumen
OBJECTIVES: Frailty syndrome predicts adverse outcomes after surgical aortic valve replacement. However, disability or comorbidity is frequently associated with preoperative frailty evaluation. The effects of these domains on early and late outcomes were analysed. METHODS: A prospective study including patients aged >/=75 years with symptomatic severe aortic stenosis who received aortic valve replacement with or without coronary artery bypass grafting was conducted. We used the Cardiovascular Health Study Frailty Phenotype to assess frailty, the Lawton-Brody index to define disability and the Charlson comorbidity index (CCI) to evaluate comorbidity. RESULTS: Frailty was identified in 57 (31%), dependence in 18 (9.9%) and advanced comorbidity (CCI >/= 4) in 67 (36.6%) of the 183 enrolled patients. Operative mortality (1.6%), transfusion rate and duration of stay increased in patients with CCI >/=4 (P < 0.005). There was a non-significant trend for these adverse outcomes among the frail patients. Follow-up was achieved in all patients (median/interquartile range 869/699-1099 days). Kaplan-Meier univariable analysis showed a reduced survival rate for frail and dependent patients and for those with multiple comorbidities (P < 0.05). According to multivariable analysis, frailty and comorbidity were independent risk factors for 1-year mortality, while disability and comorbidity, but not frailty, were risk factors for 3-year mortality (P < 0.05). CONCLUSIONS: Surgical aortic valve replacement in patients aged >/=75 years is a safe procedure with low mortality rates. Operative outcomes are mainly affected by comorbidities. The main influence of survival occurs throughout the first year, and an improved functional status prevents any progression towards disabilities, which could potentially benefit long-term outcomes. CLINICAL TRIAL REGISTRATION NUMBER: NCT02745314.