ORIGINAL ARTICLE  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2023 Nov 21

DOI: 10.23736/S0021-9509.23.12821-7

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

The association between sarcopenia and adverse outcomes after complex endovascular aortic repair

Britt W. WARMERDAM ¹, Carla S. van RIJSWIJK ², Anneke DROOP ³, Claudia J. LUCASSEN ³, Jaap F. HAMMING ¹, Jan van SCHAIK ¹, Joost R. van der VORST ¹ ✉

¹ Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; ² Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; ³ Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands

BACKGROUND: Sarcopenia is identified as a predictive factor for adverse outcomes after complex endovascular aortic repair (complex EVAR). Consensus on preferred parameters for sarcopenia is not yet reached. The current study compares three CT-assessed parameters on their association with adverse outcomes after complex EVAR.
METHODS: This was a single-center retrospective cohort study. Psoas Muscle Index (PMI), Skeletal Muscle Index (SMI), and lean psoas muscle area (LPMA) were examined by CT-segmentation. PMI, SMI, and LPMA were analyzed as continuous variables. In addition, cut-off values from previous research were used to diagnose patients as sarcopenic or non-sarcopenic. Outcomes were: all-cause mortality, major adverse events (MAE), length of hospital stay, and non-home discharge. A sub-analysis was made for severe sarcopenia; sarcopenia combined with low physical performance (gait speed, Time Up and Go test, Metabolic Equivalent of Task-score).
RESULTS: We included 101 patients. A higher PMI (HR=0.590, CI: 0.374-0.930, P=0.023), SMI (HR=0.453, CI: 0.267-0.768, P=0.003), and LPMA (HR=0.559, CI: 0.333-0.944, P=0.029) were associated with a lower risk of mortality. Sarcopenia based on cut-off values for PMI and LPMA was not significantly associated with survival. Sarcopenia based on SMI did present a higher mortality risk (P=0.017). A sub-analysis showed that severely sarcopenic patients were at even higher risk of mortality (P=0.036). None of the parameters were significantly associated with the other outcomes.
CONCLUSIONS: SMI had a slightly stronger association with mortality compared to PMI and LPMA. High-risk patients were selected by adding physical performance scores. Future research could focus on complex EVAR-specific PMI and LPMA cut-off values.

KEY WORDS: Abdominal aortic aneurysm; Endovascular aneurysm repair; Sarcopenia; Preoperative exercise