Effect of frailty in outcomes of patients undergoing cardiac surgery

Abstract

Cardiovascular diseases are still the main cause of death in older people. By foreign colleagues for a more adequate evaluation of the functional state of the senile organism the term «frailty» was proposed. The Edmonton Frailty Score was developed as a screening method for determining the degree of senile decrepitude. We evaluated the influence of the phenomenon of senile decrepitude on the outcomes of surgical treatment of patients with coronary and valvular pathology. The study included 127 patients over 65 years of age who underwent planned surgical treatment for coronary heart disease (88 patients), isolated valvular pathology (14 patients), a combination of ischemic heart disease and valvular disease (25 patients). As part of the preoperative examination, all patients were assessed the Edmonton frailty score, as a measure of qualitative assessment of the body’s functional reserves. It has been proven that the prognostic value of the frailty index, in addition to the generally accepted risk stratification scales, makes it possible to more accurately predict treatment outcomes for cardiac patients of the elderly and senile age (p<0,002). Perioperative risk factors for 30-day mortality were also analyzed. A significant contribution to the development of 30-day lethality was made both by the fact of using cardio-pulmonary bypass (p<0,001) and the time of its use (p<0,003). The overall 30-day mortality was 13,4% (17 patients): 30% (9/29 patients) in the group of «very frail» patients, 8% (6/69 patients) in the group of «moderately frail» patients and 6% (2/29 patients) in the group of «non frail» patients.

Keywords

cardiac surgery / frailty index / Edmonton frailty score / risk stratification / aging / aged patients / ischemic heart diseases / valvular heart diseases / outcomes after surgical treatment

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