Comprehensive Aortic Center, Division of Vascular and Endovascular Therapy, Keck Medical Center of University of Southern California, Los Angeles, CA.
Comprehensive Aortic Center, Division of Vascular and Endovascular Therapy, Keck Medical Center of University of Southern California, Los Angeles, CA.
J Vasc Surg. 2024 Mar;79(3):506-513.e1. doi: 10.1016/j.jvs.2023.10.052. Epub 2023 Nov 2.
Frailty, a predictor of poor outcomes, has been widely studied as a screening tool in surgical decision-making. However, the impact of frailty on the outcomes after fenestrated-branched endovascular aortic repairs (FBEVARs) is less well established. In addition, the changes in frailty during recovery after FBEVAR are unknown. We aim to assess the impact of frailty on outcomes of high-risk patients undergoing physician-modified FBEVARs for complex abdominal and thoracoabdominal aortic aneurysms, as well as the changes in frailty during follow-up.
Consecutive patients enrolled in a single-center prospective Physician-Sponsored Investigational Device Exemption protocol (FDA# G200159) were evaluated. In addition to the baseline characteristics, frailty was assessed using the Hopkins Frailty Score (HFS) and frailty index (FI) measured by the Frailty Meter. Sarcopenia was measured by L3 total psoas muscle area (PMA). These measurements were repeated during follow-up. The follow-up HFS and FI were compared with baseline scores using the Wilcoxon signed-rank test, whereas follow-up PMA measurements were compared with the baseline using the paired t test. The association between baseline frailty and morbidity was evaluated by the Wilcoxon rank-sum test.
Seventy patients were analyzed in a prospective Physician-Sponsored Investigational Device Exemption study from February 9, 2021, to June 2, 2023. At baseline, HFS identified 54% of patients as not frail, 43% as intermediately frail, and 3% as frail. Technical success of FBEVAR was 94% with one in-hospital mortality. Early major adverse events were seen in 10 (14.3%) patients. No difference in baseline FI was seen between patients with early morbidity and those without. Patients who were not frail per HFS were less likely to experience early morbidity (P = .033), and there was a significantly lower baseline PMA in patients who experienced early morbidity (P = .016). At 1 month, patients experienced a significant increase in HFS and HFS category (P = .001 and P = .01) and a significant decrease in sarcopenia (mean PMA: -96 mm, P = .005). At 6 months, HFS and HFS category as well as PMA returned toward baseline (P = .42, P = .38, and mean PMA: +4 mm, P = .6).
Preoperative frailty and sarcopenia were associated with early morbidity after physician-modified FBEVAR. During follow-up, patients became more frail and sarcopenic by 1 month. Recovery from this initial decline was seen by 6 months, suggesting that frailty and sarcopenia are reversible processes rather than a unidirectional phenomenon of continued decline.
衰弱是不良预后的预测指标，已被广泛研究作为手术决策中的筛查工具。然而，衰弱对复杂胸腹主动脉瘤的开窗分支腔内血管修复术（FBEVAR）后结局的影响尚未得到充分证实。此外，FBEVAR 后恢复期间衰弱的变化尚不清楚。我们旨在评估衰弱对高危患者接受医师改良 FBEVAR 治疗复杂腹主动脉和胸腹主动脉瘤结局的影响，以及在随访期间衰弱的变化。
对纳入的单中心前瞻性医师赞助研究设备豁免协议（FDA# G200159）的连续患者进行评估。除了基线特征外，还使用 Hopkins 衰弱评分（HFS）和衰弱计测量的衰弱指数（FI）评估衰弱。通过 L3 总腰大肌面积（PMA）测量肌肉减少症。在随访期间重复这些测量。使用 Wilcoxon 符号秩检验比较随访 HFS 和 FI 与基线评分，使用配对 t 检验比较随访 PMA 测量与基线。使用 Wilcoxon 秩和检验评估基线衰弱与发病率之间的关系。
从 2021 年 2 月 9 日至 2023 年 6 月 2 日，在一项前瞻性医师赞助研究设备豁免研究中分析了 70 名患者。基线时，HFS 确定 54%的患者无衰弱，43%的患者为中度衰弱，3%的患者为衰弱。FBEVAR 的技术成功率为 94%，住院期间有 1 例死亡。10（14.3%）例患者早期发生主要不良事件。早期发病患者的 FI 基线无差异。根据 HFS，无衰弱的患者不太可能发生早期发病（P=.033），且早期发病患者的基线 PMA 明显较低（P=.016）。1 个月时，患者的 HFS 和 HFS 类别显著增加（P=.001 和 P=.01），肌肉减少症显著减少（平均 PMA：-96mm，P=.005）。6 个月时，HFS 和 HFS 类别以及 PMA 恢复到基线（P=.42，P=.38，平均 PMA：+4mm，P=.6）。
术前衰弱和肌肉减少症与医师改良 FBEVAR 后早期发病相关。随访期间，患者在 1 个月时变得更加衰弱和肌肉减少症。6 个月时观察到这种初始下降的恢复，表明衰弱和肌肉减少症是可逆过程，而不是持续下降的单向现象。
