Thorac Cardiovasc Surg 2022; 70(S 01): S1-S61
DOI: 10.1055/s-0042-1742839
Oral and Short Presentations
Sunday, February 20
Intracorporeal Cardiac Support

Influence of Cf-VAD Implantation on the Frailty Status of Advanced Heart Failure Patients

L. Roehrich
1   Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Deutschland
,
S. Suendermann
2   Department of Cardiothoracic Surgery, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
,
I. Just
3   German Heart Institute Berlin, Berlin, Deutschland
,
L. Kopp Fernandes
1   Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Deutschland
,
J. Knierim
4   Deutsches Herzzentrum Berlin, Berlin, Deutschland
,
E. Potapov
5   Augustenburger Platz 1, Berlin, Deutschland
,
B. O'brien
6   Departments of Cardiac Anesthesiology and Intensive Care Medicine, German Heart Centre Berlin, German Heart Center Berlin, Berlin, Deutschland
,
V. Falk
7   Department of Cardiovascular Surgery, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
,
F. Schönrath
3   German Heart Institute Berlin, Berlin, Deutschland
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Background: Frailty is a potential reversible state, which affects the prognosis of advanced heart failure patients. This study aimed to examine the influence of continuous-flow ventricular assist device (cf-VAD) implantation on frailty.

Method: We evaluated frailty in 64 patients prior to and 6 months after surgery via bioelectrical impedance analysis (BIA), 6-minute-walk test (6MWT) and grip strength measurement.

Results: Postoperative phase angle increased (4.25° [IQR 3.30, 5.03] to 5.00° [IQR 4.57, 5.90]; p < 0.001) with a mean difference of 0.8°. 34 (53%) patients had a postoperative phase angle within the normal range (≥5.0°), whereas preoperative only 18 (28%) patients had a normal phase angle. Further analysis showed a significant postoperative increase in body cell mass (28.45 kg [IQR 24.60, 34.55] to 30.60 kg [IQR 26.80, 35.23]; p = 0.008) with a mean increase of 2.28 kg, while body water decreased (51.70 L [IQR: 45.25, 57.37] to 47.55 L [IQR 42.88, 52.28]; p = 0.003). Physical performance improved, evaluated by grip strength (28.50 kg [IQR 19.00, 39.00] to 33.50 kg [IQR 24.00, 43.00]; p = 0.001) and walking distance (145.00 m [IQR 0.00, 322.75] to 382.50 m [IQR 270.75, 471.00]; p < 0.001) with a mean difference of 6.5 kg resp. 192 m.

Conclusion: After cf-VAD implantation, frailty state represented by phase angle improved significantly. Further analysis of BIA parameters and physical performance confirmed that the increase of phase angle originated from increase in muscle mass and cardiac recompensation. Analysis of changes in frailty status after efficient heart failure treatment could help develop a frailty assessment, which is able to distinguish disease dependent from disease independent frailty. Early cf-VAD implantation might be able to reverse both frailty and heart failure. It should be further evaluated against stabilization of heart failure with medical therapy/short-term mechanical circulatory support in combination with prehabilitation efforts prior to cf-VAD implantation.



Publication History

Article published online:
03 February 2022

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