Objectives: The aim of this study was to seek a new predictor of mid-term survival of surgical total aortic arch replacement (SAR) by evaluating indices relevant to frailty.
Methods: Between October 2012 and March 2017, 113 consecutive patients underwent elective surgical total aortic arch replacement with antegrade cerebral perfusion under circulatory arrest at a single cardiovascular institute. In addition to common parameters, Katz index of activities of daily living, nutritional status, skeletal muscle mass volume, swallowing and motor functions were used to evaluate patients' frailty.
Results: The associated variables with mid-term all-cause death include the following: age ≥79 years was assigned 4 points; 68 years ≤age <79 years, 1 point; age <68 years, 0 point; Canadian Study of Health and Aging (CSHA) scale ≥4, 1 point; serum albumin level <3.7 g/dl, 2 points; 3.7 g/dl ≤ serum albumin level <4.25 g/dl, 1 point; serum albumin level ≥4.25 g/dl, 0 point or Katz index of activities of daily living index <6, 2 points each, according to the hazard ratio. The total score was reclassified into the low-risk (0-5) (n = 96) and high-risk (6-9) (n = 17) groups. Percentage of complicated patients was as follows: aided walking (11.5% and 47.1%; P = 0.001), dysphagia (13.5% and 41.2%; P = 0.012) and no discharge to home (13.5% and 47.1%; P = 0.003) in the low- and high-risk groups, respectively. The Kaplan-Meier curve revealed a significant decrease of 3-year survival according to the risk grades (96.2% and 33.9%; P < 0.001).
Conclusions: Risk stratification for mid-term mortality of elective surgical total aortic arch replacement was achieved by simple score relevant to frailty. The risk classification was correlated with postoperative waning of physical functions.