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Effect of malnutrition and frailty status on surgical aortic valve replacement

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Abstract

Objectives

To date, assessment of nutritional and frailty status in patients undergoing surgical aortic valve replacement remains unclear. This study aimed to assess the effect of geriatric nutritional risk index (GNRI) and Rockwood clinical frailty scale (CFS) on short-term and mid-term survival in patients who underwent surgical aortic valve replacement for aortic stenosis.

Methods

In total, 219 patients who underwent aortic valve replacement for aortic stenosis between Jan 1 2011 and Dec 31 2018 were retrospectively monitored in a single center. Mid-term survival was assessed using Kaplan–Meier analysis. Logistic and Cox regression analyses were performed to detect independent predictors for early and mid-term mortality. Follow-up was 97.7% complete, and a GNRI score ≤ 98 denoted malnutrition.

Results

In the univariable analysis, GNRI [odds ratio (OR) 0.91, 95% confidence interval (CI), 0.86–0.96, p < 0.001] and CFS (OR 2.00 95% CI 1.38–2.94, p < 0.001) were identified as significant risk factors for in-hospital mortality. Mid-term survival was significantly decreased in patients with malnutrition (3 and 5 year survival rates 83.9 and 76.9%, respectively, p < 0.001). Mid-term freedom from major cardiac and cerebrovascular events was significantly decreased in patients with malnutrition (p = 0.039). The CFS (hazard ratio 1.78) and GNRI (hazard ratio 0.95) were independent risk factors for mid-term survival in the univariable and multivariable analyses, respectively.

Conclusions

A lower GNRI is associated with poor mid-term mortality and major cardiac and cerebrovascular events after surgical aortic valve replacement. A lower CFS score is associated with unfavorable mid-term outcomes.

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References

  1. Barreto-Filho JA, Wang Y, Dodson JA, Desai MM, Sugeng L, Geirsson A, et al. Trends in aortic valve replacement for elderly patients in the United States, 1999–2011. JAMA. 2013;310:2078–85.

    Article  CAS  Google Scholar 

  2. Piazza N, van Gameren M, Jüni P, Wenaweser P, Carrel TP, Onuma Y, et al. A comparison of patient characteristics and 30-day mortality outcomes after transcatheter aortic valve implantation and surgical aortic valve replacement for the treatment of aortic stenosis: a two-centre study. EuroIntervention. 2009;5:580–8.

    Article  Google Scholar 

  3. Piazza N, Kalesan B, van Mieghem N, Head S, Wenaweser P, Carrel TP, et al. A 3-center comparison of 1-year mortality outcomes between transcatheter aortic valve implantation and surgical aortic valve replacement on the basis of propensity score matching among intermediate-risk surgical patients. JACC Cardiovas Interv. 2013;6:443–51.

    Article  Google Scholar 

  4. Shimura T, Yamamoto M, Kano S, Kagase A, Kodama A, Koyama Y, et al. Impact of the clinical frailty scale on outcomes after transcatheter aortic valve replacement. Circulation. 2017;135:2013–24.

    Article  Google Scholar 

  5. Afilalo J, Lauck S, Kim DH, Lefèvre T, Piazza N, Lachapelle K, et al. Frailty in older adults undergoing aortic valve replacement. J Am Coll Cardiol. 2017;70:689–700.

    Article  Google Scholar 

  6. Johnston DR, Soltesz EG, Vakil N, Rajeswaran J, Roselli EE, Sabik JF, et al. Long-term durability of bioprosthetic aortic valves: Implications from 12,569 implants. Ann Thorac Surg. 2015;99:1239–47.

    Article  Google Scholar 

  7. Haneda N, Miyata H, Motomura N, Nishina T, Takamoto S. 2012 Japan Adult Cardiovascular Database Organization. Procedure and age-specific risk stratification of single aortic valve replacement in elderly patients based on Japan adult cardiovascular surgery database. Circ J. 2012;76:356–64.

    Article  Google Scholar 

  8. Wei K, Nyunt MS, Gao Q, Wee SL, Yap KB, Ng TP. Association of frailty and malnutrition with long-term functional and mortality outcomes among community-dwelling older adults: Results from the Singapore longitudinal aging study 1. JAMA Netw Open. 2018. https://doi.org/10.1001/jamanetworkopen.2018.0650.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, et al. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82:777–83.

    Article  CAS  Google Scholar 

  10. Lee K, Ahn JM, Kang DY, Ko E, Kwon O, Lee PH, et al. Nutritional status and risk of all-cause mortality in patients undergoing transcatheter aortic valve replacement assessment using the geriatric nutritional risk index and the controlling nutritional status score. Clin Res Cardiol. 2020;109:161–71.

    Article  Google Scholar 

  11. Shibata K, Yamamoto M, Kano S, Koyama Y, Shimura T, Kagase A, et al. Importance of geriatric nutritional risk index assessment in patients undergoing transcatheter aortic valve replacement. Am Heart J. 2018;202:68–75.

    Article  Google Scholar 

  12. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J. 2005;173:489–95.

    Article  Google Scholar 

  13. Xiong J, Wang M, Zhang Y, Nie L, He T, Wang Y, et al. Association of geriatric nutritional risk index with mortality in hemodialysis patients: A meta-analysis of cohort studies. Kidney Blood Press Res. 2018;43:1878–89.

    Article  Google Scholar 

  14. Xie J, Tang S, Wei L, Gan J. Geriatric nutritional risk index as a predictor of complications and long-term outcomes in patients with gastrointestinal malignancy: a systematic review and meta-analysis. Cancer Cell Int. 2020;20:530.

    Article  Google Scholar 

  15. Kopple JD. Nutritional status as a predictor of morbidity in maintenance dialysis patients. ASAIO J. 1997;43:246–50.

    CAS  PubMed  Google Scholar 

  16. Rosenberger J, Kissova V, Majernikova M, Straussova Z, Boldizsar J. Body composition monitor assessing malnutrition in the hemodialysis population independently predicts mortality. J Ren Nutr. 2014;24:172–6.

    Article  Google Scholar 

  17. Lomivorotov VV, Efremov SM, Boboshko VA, Nikolaev DA, Vedernikov PE, Lomivorotov VN, et al. Evaluation of nutritional screening tools for patients scheduled for cardiac surgery. Nutrition. 2013;29:436–42.

    Article  Google Scholar 

  18. Lomivorotov VV, Efremov SM, Boboshko VA, Nikolaev DA, Vedernikov PE, Deryagin MN, et al. Prognostic value of nutritional screening tools for patients scheduled for cardiac surgery. Interact Cardiovasc Thorac Surg. 2013;16:612–8.

    Article  Google Scholar 

  19. Jie B, Jiang ZM, Zhu SN, Yu K, Kondrup J. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition. 2012;28:1022–7.

    Article  Google Scholar 

  20. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–57.

    Article  CAS  Google Scholar 

  21. Green P, Arnold SV, Cohen DJ, Kirtane AJ, Kodali SK, Brown DL, et al. Relation of frailty to outcomes after transcatheter aortic valve replacement (from the PARTNER Trial). Am J Cardiol. 2015;116:264–9.

    Article  Google Scholar 

  22. Li Z, Dawson E, Moodie J, Martin J, Bagur R, Cheng D, et al. Frailty in patients undergoing transcatheter aortic valve implantation: a protocol for a systematic review. BMJ Open. 2019. https://doi.org/10.1136/bmjopen-2018-024163.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank Editage (www.editage.jp) for English language editing. We would like to thank Mr. Suto and colleagues who are trained medical professionals for evaluating the clinical frailty scale. We would like to thank Ms. Soma and Kudo for assisting in data curation.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital, 2-1-1 Higashi-Tsukurimichi, Aomori, 030-8553, Japan

    Masaaki Naganuma, Yasushi Kudo, Nobuaki Suzuki, Shinya Masuda & Koichi Nagaya

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  1. Masaaki Naganuma
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  2. Yasushi Kudo
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  3. Nobuaki Suzuki
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  4. Shinya Masuda
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Correspondence to Masaaki Naganuma.

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Naganuma, M., Kudo, Y., Suzuki, N. et al. Effect of malnutrition and frailty status on surgical aortic valve replacement. Gen Thorac Cardiovasc Surg 70, 24–32 (2022). https://doi.org/10.1007/s11748-021-01667-5

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  • DOI: https://doi.org/10.1007/s11748-021-01667-5

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