Effect of malnutrition and frailty status on surgical aortic valve replacement

Naganuma, M.; Kudo, Yasusei; Suzuki, Nobuaki; Masuda, Shinji; Nagaya, Koichi

doi:10.1007/s11748-021-01667-5

Cited by 10 publications

(4 citation statements)

References 21 publications

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“…Commonly used frailty assessment tools have been discussed elsewhere. 28 In the surgical setting, a variety of tools has been used, such as the modified 5‐Item Frailty Index (mFI‐5), 103 the Geriatric Nutritional Risk Index, 104 the Rockwood Clinical Frailty Scale, 105 the Edmonton Frail Scale, 106 and the Fried frailty criteria. 107 In regard to screening tools, newer, easy‐to‐use instruments such as the Sunfrail ( http://www.sunfrail.eu/ ), consistent with the biopsychosocial model, is now available, 108 although its use in surgery is yet to be explored.…”

Section: Assessing Malnutrition: a Focus On Novel And Nascent Methodsmentioning

confidence: 99%

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Prado

Ford

Gonzalez

et al. 2022

J Parenter Enteral Nutr

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Preoperative nutrition status is an important determinant of surgical outcomes, yet malnutrition assessment is not integrated into all surgical pathways. Given its importance and the high prevalence of malnutrition in patients undergoing surgical procedures, preoperative nutrition screening, assessment, and intervention are needed to improve postoperative outcomes. This narrative review discusses novel methods to assess malnutrition and frailty in the surgical patient. The Global Leadership Initiative for Malnutrition (GLIM) criteria are increasingly used in surgical settings although further spread and implementation are strongly encouraged to help standardize the diagnosis of malnutrition. The use of body composition (ie, reduced muscle mass) as a phenotypic criterion in GLIM may lead to a greater number of patients identified as having malnutrition, which may otherwise be undetected if screened by other diagnostic tools. Skeletal muscle loss is a defining criterion of malnutrition and frailty. Novel direct and indirect approaches to assess muscle mass in clinical settings may facilitate the identification of patients with or at risk for malnutrition. Selected imaging techniques have the additional advantage of identifying myosteatosis (an independent predictor of morbidity and mortality for surgical patients). Feasible pathways for screening and assessing frailty exist and may determine the cost/benefit of surgery, long‐term independence and productivity, and the value of undertaking targeted interventions. Finally, the evaluation of nutrition risk and status is essential to predict and mitigate surgical outcomes. Nascent to novel approaches are the future of objectively identifying patients at perioperative nutrition risk and guiding therapy toward optimal perioperative standards of care.

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Section: Assessing Malnutrition: a Focus On Novel And Nascent Methodsmentioning

confidence: 99%

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Prado

Ford

Gonzalez

et al. 2022

J Parenter Enteral Nutr

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“…Data published by Miguelena were only collected up to 6 months postprocedure. 17 Isolated SAVR patients alone are included in three out of four SAVR studies (56% of patients in the study by Naganuma et al underwent a concomitant valve or coronary bypass procedure 18 ).…”

Section: Resultsmentioning

confidence: 99%

“…Applicability concerns were raised for studies by Kleczynski (due to the median STS score of 12% indicating a higher baseline risk in this group) and Naganuma (due to greater than 50% of patients undergoing an additional procedure at the time of AVR). 18 21 It was also noted that a high number of SAVR patients (879/1253) screened as part of the Afilalo study were not enrolled, most commonly due to patient and/or researcher unavailability for a preprocedure interview, which may have predisposed to selection bias. 15 …”

Section: Resultsmentioning

confidence: 99%

Clinical Frailty Scale as a predictor of adverse outcomes following aortic valve replacement: a systematic review and meta-analysis

et al. 2023

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ObjectivesAssessment of frailty prior to aortic valve intervention is recommended in European and North American valvular heart disease guidelines. However, there is a lack of consensus on how it is best measured. The Clinical Frailty Scale (CFS) is a well-validated measure of frailty that is relatively quick to calculate. This meta-analysis sought to examine whether the CFS predicts mortality and morbidity following either transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR).MethodsNine electronic databases were searched systematically for data on clinical outcomes post-TAVI/SAVR, where patients had undergone preoperative frailty assessment using the CFS. The primary endpoint was 12-month mortality. TAVI and SAVR data were assessed and reported separately. For each individual study, the incidence of adverse outcomes was extracted according to a CFS score of 5–9 (ie, frail) versus 1–4 (ie, non-frail), with meta-analysis performed using a random effects model.ResultsOf 2612 records screened, nine were included in the review (five TAVI, three SAVR and one which included both interventions). Among 4923 TAVI patients, meta-analysis showed 12-month mortality rates of 19.1% for the frail cohort versus 9.8% for the non-frail cohort (RR 2.53 (1.63 to 3.95), p<0.001, I2=83%). For the smaller cohort of SAVR patients (n=454), mortality rates were 20.3% versus 3.9% for the frail and non-frail cohorts, respectively (RR 5.08 (2.31 to 11.15), p<0.001, I2=5%).ConclusionsFrailty, as determined by the CFS, was associated with an increased mortality risk in the 12 months following either TAVI or SAVR. These data would support its use in the preoperative assessment of elderly patients undergoing aortic valve interventions.

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“…Although older patients do not necessarily always meet the definition of ‘frail’, there is a significant correlation between advanced age and frailty as discussed above. In the setting of cardiac surgery, frail patients fare worse than nonfrail counterparts in metrics, such as ICU and hospital length of stay [16 ▪ ,17 ▪ ], readmission rate [17 ▪ ,18 ▪ ], associated costs/utilization of resources [18 ▪ ,19], and mortality [16 ▪ ,19,20 ▪ ,21–23]. Not only is in-hospital increased in the frail population [16 ▪ ,19], but long-term mortality, up to 1 year, is increased by four-fold in frail patients undergoing cardiac surgery ( n = 604, OR = 4.63, 95% CI = 2.21–9.69, P < 0.001) [20 ▪ ].…”

Section: Frailty In Cardiac Surgerymentioning

confidence: 99%

Frailty and cardiac surgery: to operate or not?

Emmert¹,

Arcario²,

Maranhao³

et al. 2021

Current Opinion in Anaesthesiology

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Purpose of reviewWith an aging cardiac surgery population, prefrail and frail patients are becoming more common. Anesthesiologists will be faced with the decision of how best to provide care to frail patients. Identification, management, and outcomes in frail patients will be discussed in this review. Recent findingsFrailty is associated with a variety of poor outcomes, such as increased hospital length of stay, medical resource utilization, readmission rates, and mortality. Prehabilitation may play a greater role in the management of frail cardiac surgery patients.

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Effect of malnutrition and frailty status on surgical aortic valve replacement

Cited by 10 publications

References 21 publications

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Clinical Frailty Scale as a predictor of adverse outcomes following aortic valve replacement: a systematic review and meta-analysis

Frailty and cardiac surgery: to operate or not?

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