Psoas muscle size as a frailty measure for open and transcatheter aortic valve replacement
Psoas muscle size as a frailty measure for open and transcatheter aortic valve replacement
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腰大肌大小作为开放和经导管主动脉瓣置换术的脆弱指标
DOI：
10.1016/j.jtcvs.2015.11.022
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发表时间：
2016-03-01
影响因子：
6
通讯作者：
Patel, Himanshu J.
中科院分区：
文献类型：
--
作者：
Paknikar, Raghavendra;Friedman, Jeffrey;Patel, Himanshu J.
目的：评估肌肉减少症作为接受外科主动脉瓣置换术（SAVR）或经导管主动脉瓣置换术（TAVR）的主动脉瓣狭窄患者的虚弱评估工具的使用方法：研究队列包括295例接受SAVR（n = 156）或TAVR（n = 139）的患者。平均术前胸外科医师协会死亡风险评分为4.7%。术前CT扫描用于计算性别标准化的腰大肌总面积（TPA），作为一个有效的测量肌肉减少症的指标。结果：对于整个队列，30天死亡、卒中、肾功能衰竭、长期通气和深部伤口感染的综合指标的独立预测因子包括术前STS主要发病率和死亡风险评分（比值比[OR]，91.1; P = 0.02）和TPA（OR，0.5; P = 0.024）。肌肉减少症患者的两年生存率为85.7%，而无肌肉减少症患者的两年生存率为93.8%（P = 0.02）。晚期生存的独立预测因子包括TPA（风险比，0.47; P = .02）。男性（OR，0.52; P = 0.04）和TPA（OR，0.6; P = 0.001）是高资源利用的预测因素。按治疗组进行的单独分析发现，TPA预测SAVR后的高资源利用率（OR，0.4; P
Objective: To evaluate the use of sarcopenia as a frailty assessment tool for patients with aortic stenosis undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR).Methods: The study cohort comprised 295 patients who underwent either SAVR (n = 156) or TAVR (n = 139). The mean preoperative Society of Thoracic Surgeons mortality risk score was 4.7%. Preoperative computed tomography (CT) scans were used to calculate gender-standardized total psoas area (TPA), as a validated measure of sarcopenia.Results: For the entire cohort, independent predictors of a composite measure of 30-day death, stroke, renal failure, prolonged ventilation, and deep wound infection included preoperative STS major morbidity and mortality risk score (odds ratio [OR], 91.1; P = .02) and TPA (OR, 0.5; P = .024). Two-year survival was 85.7% in patients with sarcopenia, compared with 93.8% in patients without sarcopenia (P = .02). Independent predictors of late survival included TPA (hazard ratio, 0.47; P = .02). Male sex (OR, 0.52; P = .04) and TPA (OR, 0.6; P = .001) were predictive of high resource utilization. A separate analysis by treatment group found that TPA predicted high resource utilization after SAVR (OR, 0.4; P