Bacchi Beatrice, Cabrucci Francesco, Petrone Dario, Bessi Giulia, Pacini Tommaso, Dokollari Aleksander, Bonacchi Massimo
Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy.
Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA.
J Clin Med. 2025 Jul 8;14(14):4833. doi: 10.3390/jcm14144833.
Frailty is increasingly recognized as a key determinant of surgical risk in elderly patients undergoing aortic valve replacement (AVR). This study aimed to evaluate the prognostic value of the modified Frailty Index (mFI) in a homogeneous cohort of octogenarians undergoing minimally invasive surgical AVR, to enhance risk stratification and guide surgical decision-making. We retrospectively analyzed 67 patients aged ≥ 80 years (mean 84.1 ± 3.2) who underwent isolated minimally invasive AVR. The mFI was calculated preoperatively using standardized clinical variables. Primary outcomes included 30-day mortality and perioperative complications; long-term survival was also assessed. Receiver operating characteristic (ROC) curves identified optimal mFI cut-offs. Kaplan-Meier and Cox regression analyses were used to evaluate survival and predictors of mortality. The mFI demonstrated a strong prognostic accuracy. An mFI > 0.455 predicted 30-day mortality with 81.8% sensitivity and 88.4% specificity (AUC = 0.888, < 0.001), while an mFI > 0.273 predicted perioperative complications (AUC = 0.818, < 0.001). During a median follow-up of 51.8 ± 36.4 months, 24 patients (45.3%) died. One-year survival was 83.7%. The mFI > 0.455 was the strongest independent predictor of early mortality (HR 6.34, = 0.001); mFI > 0.273, HFpEF with NT-proBNP > 1000 pg/mL, and chronic kidney disease were predictors of long-term mortality. The mFI is a simple, reproducible tool that reliably predicts early and late outcomes in very elderly patients undergoing minimally invasive AVR. Integrating frailty into preoperative evaluation may improve patient selection by prioritizing physiological over chronological age.
衰弱日益被认为是接受主动脉瓣置换术（AVR）的老年患者手术风险的关键决定因素。本研究旨在评估改良衰弱指数（mFI）在接受微创外科AVR的八旬老人同质队列中的预后价值，以加强风险分层并指导手术决策。我们回顾性分析了67例年龄≥80岁（平均84.1±3.2岁）接受单纯微创AVR的患者。术前使用标准化临床变量计算mFI。主要结局包括30天死亡率和围手术期并发症；还评估了长期生存率。受试者工作特征（ROC）曲线确定了最佳mFI临界值。采用Kaplan-Meier和Cox回归分析评估生存率和死亡率预测因素。mFI显示出很强的预后准确性。mFI>0.455预测30天死亡率的敏感性为81.8%，特异性为88.4%（AUC=0.888，P<0.001），而mFI>0.273预测围手术期并发症（AUC=0.818，P<0.001）。在中位随访51.8±36.4个月期间，24例患者（45.3%）死亡。1年生存率为83.7%。mFI>0.455是早期死亡率的最强独立预测因素（HR 6.34，P=0.001）；mFI>0.273、NT-proBNP>1000 pg/mL的射血分数保留的心力衰竭（HFpEF）和慢性肾脏病是长期死亡率的预测因素。mFI是一种简单、可重复的工具，可可靠地预测接受微创AVR的高龄患者的早期和晚期结局。将衰弱纳入术前评估可能通过优先考虑生理年龄而非实际年龄来改善患者选择。
