Chatterjee Subhasis, Shi Ann, Yoon Luke, Green Susan Y, Zhang Qianzi, Amarasekara Hiruni S, Orozco-Sevilla Vicente, Preventza Ourania, LeMaire Scott A, Coselli Joseph S
Division of General Surgery, Department of Surgery, Baylor College Medicine, Houston, Tex; Division of Cardiothoracic Surgery, Department of Surgery, Baylor College Medicine, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex.
CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Department of Radiology, Baylor College Medicine, Houston, Tex.
J Thorac Cardiovasc Surg. 2023 Jun;165(6):1985-1996.e3. doi: 10.1016/j.jtcvs.2021.05.037. Epub 2021 Jun 4.
Sarcopenia (core muscle loss) has been used as a surrogate marker of frailty. We investigated whether sarcopenia would adversely affect survival after thoracoabdominal aortic aneurysm repair.
We retrospectively reviewed prospectively collected data from patients aged 60 years or older who underwent thoracoabdominal aortic aneurysm repairs from 2006 to 2016. Imaging was reviewed by 2 radiologists blinded to clinical outcomes. The total psoas index was derived from total psoas muscle cross-sectional area (cm) at the mid-L4 level, normalized for height (m). Patients were divided by sex-specific total psoas index values into sarcopenia (lower third) and nonsarcopenia (upper two-thirds) groups. Multivariable modeling identified operative mortality and spinal cord injury predictors. Unadjusted and adjusted survival curves were analyzed.
Of 392 patients identified, those with sarcopenia (n = 131) were older than nonsarcopenic patients (n = 261) (70.0 years vs 68.0 years; P = .02) and more frequently presented with aortic rupture or required urgent/emergency operations. Operative mortality was comparable (sarcopenia 13.7% vs nonsarcopenia 10.0%; P = .3); sarcopenia was not associated with operative mortality in the multivariable model (odds ratio, 1.40; 95% confidence interval, 0.73-2.77; P = .3). Sarcopenic patients experienced more frequent delayed (13.0% vs 4.6%; P = .005) and persistent (10.7% vs 3.4%; P = .008) paraplegia. Sarcopenia independently predicted delayed paraplegia (odds ratio, 3.17; 95% confidence interval, 1.42-7.08; P = .005) and persistent paraplegia (odds ratio, 3.29; 95% confidence interval, 1.33-8.13; P = .01) in the multivariable model. Adjusted for preoperative/operative covariates, midterm survival was similar for sarcopenic and nonsarcopenic patients (P = .3).
Sarcopenia did not influence early mortality or midterm survival after thoracoabdominal aortic aneurysm repair but was associated with greater risk for delayed and persistent paraplegia.
肌肉减少症（核心肌肉量流失）已被用作虚弱的替代标志物。我们研究了肌肉减少症是否会对胸腹主动脉瘤修复术后的生存产生不利影响。
我们回顾性分析了2006年至2016年期间接受胸腹主动脉瘤修复术的60岁及以上患者的前瞻性收集数据。由2名对临床结果不知情的放射科医生对影像进行评估。总腰大肌指数由L4水平中部的总腰大肌横截面积（cm）得出，并根据身高（m）进行标准化。根据性别特异性总腰大肌指数值将患者分为肌肉减少症组（下三分之一）和非肌肉减少症组（上三分之二）。多变量建模确定了手术死亡率和脊髓损伤的预测因素。分析了未调整和调整后的生存曲线。
在392名确定的患者中，肌肉减少症患者（n = 131）比非肌肉减少症患者（n = 261）年龄更大（70.0岁对68.0岁；P = 0.02），并且更频繁地出现主动脉破裂或需要紧急/急诊手术。手术死亡率相当（肌肉减少症组为13.7%，非肌肉减少症组为10.0%；P = 0.3）；在多变量模型中，肌肉减少症与手术死亡率无关（比值比，1.40；95%置信区间，0.73 - 2.77；P = 0.3）。肌肉减少症患者发生延迟性截瘫（13.0%对4.6%；P = 0.005）和持续性截瘫（10.7%对3.4%；P = 0.008）的频率更高。在多变量模型中，肌肉减少症独立预测延迟性截瘫（比值比，3.17；95%置信区间，1.42 - 7.08；P = 0.005）和持续性截瘫（比值比，3.29；95%置信区间，1.33 - 8.13；P = 0.01）。在对术前/手术协变量进行调整后，肌肉减少症患者和非肌肉减少症患者的中期生存率相似（P = 0.3）。
肌肉减少症不影响胸腹主动脉瘤修复术后的早期死亡率或中期生存率，但与延迟性和持续性截瘫的风险增加有关。
