Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann Hospital, Houston, Texas.
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann Hospital, Houston, Texas.
Ann Thorac Surg. 2018 Nov;106(5):1333-1339. doi: 10.1016/j.athoracsur.2018.05.060. Epub 2018 Jun 23.
Sarcopenia may be an indicator of frailty. We used the total psoas area index (TPAI) to identify sarcopenia and evaluated the effect of preoperative TPAI on outcomes after descending thoracic aortic aneurysm (DTAA) repair.
Patients with DTAA between 2007 and 2015 who were undergoing thoracic endovascular aortic repair (TEVAR) and open surgical repair (OSR) with available preoperative imaging were analyzed. Sarcopenia was defined as TPAI <6.5cm/m. An adverse event was defined as the composite endpoint of three or more multisystem complications, discharge to other than home, or death within 30 days.
A total of 282 of 386 DTAA repairs had imaging available for TPAI measurements; 71 of 282 (25%) patients underwent TEVAR, and 211 of 282 (75%) underwent OSR. Preoperative sarcopenia was similar in the two groups (OSR, 57% vs TEVAR, 48%, p = 0.188). Risk factors for sarcopenia were age >70 years, female sex, and large body surface area, whereas heritable thoracic aortic disease was a protective factor. OSR-treated patients with sarcopenia were older compared with patients without sarcopenia (p < 0.001), whereas TEVAR-treated patients had a similar age category distribution (p = 0.187). Patients with sarcopenia had significantly increased adverse events compared with patients who did not have sarcopenia in both groups (sarcopenia-TEVAR, 41% vs nonsarcopenia-TEVAR, 16%, p = 0.020; sarcopenia-OSR, 49% vs nonsarcopenia-OSR, 32%, p = 0.012). Determinants of long-term mortality were increasing age (parameter estimate [PE], 0.06, p < 0.001), TPAI as a decreasing linear function (PE, 0.36, p = 0.003), OSR (PE, 2.92, p = 0.003), and interaction between OSR and TPAI (PE, -0.34, p = 0.010). The interaction term showed that OSR increases long-term mortality risk in more sarcopenic patients.
Preoperative sarcopenia significantly correlated with postoperative adverse events and long-term mortality after DTAA repair. If anatomically feasible, TEVAR should be considered in sarcopenic patients.
肌少症可能是衰弱的一个指标。我们使用总腰大肌面积指数（TPAI）来识别肌少症，并评估术前 TPAI 对降主动脉瘤（DTAA）修复后结局的影响。
对 2007 年至 2015 年间接受胸主动脉腔内修复术（TEVAR）和开放手术修复（OSR）治疗且有术前影像学资料的 DTAA 患者进行分析。肌少症定义为 TPAI<6.5cm/m。不良事件定义为三个或更多多系统并发症、出院至非家庭场所或 30 天内死亡的复合终点。
共有 386 例 DTAA 修复术中有 282 例有 TPAI 测量的影像学资料；71 例患者接受 TEVAR，211 例患者接受 OSR。两组术前肌少症发生率相似（OSR，57% vs TEVAR，48%，p=0.188）。肌少症的危险因素为年龄>70 岁、女性和较大的体表面积，而遗传性胸主动脉疾病是一个保护因素。与无肌少症患者相比，OSR 治疗的肌少症患者年龄更大（p<0.001），而 TEVAR 治疗的患者年龄分布相似（p=0.187）。两组肌少症患者的不良事件发生率明显高于无肌少症患者（肌少症-TEVAR，41% vs 非肌少症-TEVAR，16%，p=0.020；肌少症-OSR，49% vs 非肌少症-OSR，32%，p=0.012）。长期死亡率的决定因素是年龄增加（参数估计[PE]，0.06，p<0.001）、TPAI 呈递减线性函数（PE，0.36，p=0.003）、OSR（PE，2.92，p=0.003）和 OSR 与 TPAI 之间的相互作用（PE，-0.34，p=0.010）。交互项表明，在更严重的肌少症患者中，OSR 增加了长期死亡率的风险。
术前肌少症与 DTAA 修复术后不良事件和长期死亡率显著相关。如果解剖学上可行，应考虑在肌少症患者中进行 TEVAR。
