Deleterious effects of loss of independence assessed with the KATZ index after aortic valve replacement in elderly patient

Ngo Thanh Hung, Tran Thuy Nguyen, Nguyen The Huy, Nguyen Hoang Nam, CAMILLERI Lionel

##plugins.themes.bootstrap3.article.main##

Tóm tắt

Introduction: Surgical operative risk of valvular replacement has been widely studied and it has been shown that postoperative complications incidence and mortality increase with patients’ age. The aim of this study was to assess among elderly patients whom underwent surgical aortic valve replacement using various scoring system and Geriatric Assessment Indexes to predict post-operative risk and long-term outcome. Methods and Results: We prospectively evaluated the incidence, over early and late results, of surgical scores and geriatric profile amid 122 intermediate-risk patients, aged 75 years or more who underwent surgical aortic valve replacement. In a univariate analysis, the EuroScore II (OR 1.73, 95% CI: 1.21-2.48, P =0.002), STS score (OR 1.39, 95% CI: 1.03-1.88, P = 0.03) and a Katz index ≤ 5 (limitation of at least one daily living activity) (OR 3.35, 95% CI: 1.08-10.35, P=0.03) were predictors of a 30-day unfavorable evolution. In a multivariate analysis, only surgical scores were predictive factors. At 6 months, 20 patients had deceased or had to be readmitted to hospital. At 10 years, survival was 48 % [IQR 39-57]. The Katz index ≤ 5 was the only geriatric test independent of an unfavorable outcome at 6 months (OR 4.51, 95% CI: 1.25-16.29, P = 0.02) and of a deleterious effect over long-term survival (OR 3.00, 95% CI: 1.58-5.69, P=0.001). Conclusion: In elderly patients, autonomy assessment with the Katz index allows to distinguish a vulnerable population with less beneficial outcomes after aortic valve replacement.

##plugins.themes.bootstrap3.article.details##

Tài liệu tham khảo

1. Feringa HH, Bax JJ, Karagiannis SE, Noordzij P et al. Elderly patients undergoing major vascular surgery: risk factors and medication associated with risk reduction. Arch Gerontol Geriat 2009; 48: 116-20.
2. Prins C, de Villiers Jonker I, Botes L, Smit FE.. Cardiac surgery risk-stratification models. Cardiovasc J Afr 2012; 23: 160–4
3. Barili F, Pacini D, Capo A, et al. Does EuroSCORE II perform better than its original versions? A multicenter validation study. Eur Heart J 2013 ;34 :22-9.
4. Dewey TM, Brown D, Ryan, WH, et al. Reliability of risk algorithms in predicting early and late operative outcomes in high-risk patients undergoing aortic valve replacement. J Thoracic Cardiovasc Surg 2008; 135:180-7.
5. Afilalo J, Karunananthan S, Eisenberg MJ, et al. Role of frailty in patients with cardiovascular disease. Am J Cardiol 2009; 103:1616-21.
6. Gallo M. Multiparameter approach to evaluate elderly patients undergoing aortic valve replacement. J Thorac Cardiovasc Surg 2014; 148:1749-51.
7. Shea Gluhm, BA, Jody Goldstein, et all. Cognitive Performance on the Mini-Mental State Examination and the Montreal Cognitive Assessment Across the Healthy Adult Lifespan. Cogn Behav Neurol 2013; 26: 1–5
8. Shelkey M, Wallace M. Katz index of independence in activities of daily living. J Gerontol Nurs 1999; 25: 8–9
9. Ng SS, Hui-Chan CW. The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke. Arch Phys Med Rehabil. 2005 Aug; 86: 1641-7.
10. Rosenhek R, Iung B, Tornos P, et all. ESC Working group on valvular heat disease position paper: assessing the risk of interventions in patients with valvular heart disease. Eur Heart J 2012;13:822-8.
11. Lee DH, Buth KJ, Martin Bj, et all. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation 2010; 121: 973-8.
12. Sanchez E, Vidan MT, Serra JA, et all. Prevalence of geriatric syndromes and impact on clinical and functional outcomes in older patients with acute cardiac diseases. Heart 2011; 97:1602-6.
13. Schoenenberger AW, Stortecky S, Neumann S, et all. Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation. European Heart Journal 2013; 34: 684-92.
14. Singh M, Rihal CS, Lennon RJ, et all. Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes 2011; 4:496–502.
15. Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol Med Sci 2004; 59:255-263.
16. Afilalo J, Eisenberg MJ, Morin JF, et all. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol 2010; 56:1668-76.
17. Sûndermann S, Dademasch A, Praetorius J Kempfert J, et all. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardio-thoracic Surg 2011; 39: 33-7.
18. Green P, Woglom AE, Genereux P, et all. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis. J Am Coll Cardiol Intv 2012; 5:974-81.
19. Sepehri A, Beggs T, et all. The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg 2014; 148:3110-7.
20. Green P, Woglom AE, Genereux P, et all. Gait speed and dependence in activities of daily living in older adults with severe aortic stenosis. Clin Cardiol 2012; 35:307- 14.
21. Fukuse T, Satoda N, Hijiya K, Fujinaga T. Importance of a comprehensive geriatric assessment in prediction of complications following thoracic surgery in elderly patients. Chest. 2005: 127:886-91.
22. Puls M, Sobisiak B, Bleckmann A, et all. Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living. EuroIntervention 2014; 10:609-19.