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General Thoracic and Cardiovascular Surgery

, Volume 63, Issue 8, pp 425–433 | Cite as

Frailty in cardiothoracic surgery: systematic review of the literature

  • Hiroshi FurukawaEmail author
  • Kazuo Tanemoto
Review Article

Abstract

A preoperative surgical risk analysis is necessary and important for predicting clinical and surgical outcomes in a clinical setting. Various tools for evaluating the patient characteristics in order to forecast perioperative clinical outcomes have previously been described; however, an objective and precise preoperative risk assessment has not yet been established. In the last decade, the concept of frailty, which is a geriatric assessment that identifies disabilities and weaknesses in patients, has been used in order to predict clinical mortality and morbidity following invasive surgical interventions because the prevalence of elderly patients among those undergoing surgical interventions is increasing. Since there is currently no single generally accepted clinical definition of frailty, many clinical modalities are needed to evaluate the patients’ geriatric activity of daily living. Quantifying the quality of frailty is an evolving challenge for predicting surgical risks preoperatively. In recent years, with the development of transcatheter aortic valve implantation (TAVI), this newly definitive preoperative surgical risk assessment tool, frailty, has become more important and is attracting interest in cardiothoracic surgical settings. Thus, this review summarized current consideration on the preoperative risk analysis by frailty as well as future perspectives and the potential of an ideal frailty risk assessment in cardiothoracic surgery, including the management of elderly patients and high-risk aortic valve stenosis by TAVI.

Keywords

Frailty Elderly patients Thoracic surgery Cardiac surgery Transcatheter aortic valve implantation 

Notes

Conflict of interest

There is no conflict of interest to declare.

References

  1. 1.
    Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA. 2014;311:2110–20.CrossRefPubMedGoogle Scholar
  2. 2.
    Collard RM, Boter H, Schoevers RA, Voshaar RCO. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60:1487–92.CrossRefPubMedGoogle Scholar
  3. 3.
    Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95.PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:752–62.CrossRefPubMedGoogle Scholar
  5. 5.
    Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, et al. Gait speed and survival in older adults. JAMA. 2011;305:50–8.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Spiliopoulos K, Bagiatis V, Deutsch O, Kemkes BM, Antonopoulos N, Karangelis D, et al. Performance of EuroSCORE II compared to EuroSCORE I in predicting operative and mid-term mortality of patients from a single center after combined coronary artery bypass grafting and aortic valve replacement. Gen Thorac Cardiovasc Surg. 2014;62:103–11.CrossRefPubMedGoogle Scholar
  7. 7.
    Guida P, Mastro F, Scrascia G, Whitlock R, Paparella D. Performance of the European system for cardiac operative risk evaluation II: a meta-analysis of 22 studies involving 145,592 cardiac surgery procedures. J Thorac Cardiovasc Surg. 2014;148:3049–57.CrossRefPubMedGoogle Scholar
  8. 8.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148:e1–132.CrossRefPubMedGoogle Scholar
  9. 9.
    Sepehri AC, Beggs T, Hassan A, Rigatto C, Shaw-Daigle C, Tangri N, et al. The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg. 2014;148:3110.CrossRefPubMedGoogle Scholar
  10. 10.
    de Arenaza DP, Pepper J, Lees B, Rubinstein F, Nugara F, Roughton M, et al. Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergoing aortic valve replacement. Heart. 2010;96:113–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Lee DH, Buth KJ, Martin BJ, Yip AM, Hirsch GM. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation. 2010;121:973–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Afilalo J, Eisenberg MJ, Morin JF, Bergman H, Monette J, Noiseux N, et al. 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.CrossRefPubMedGoogle Scholar
  13. 13.
    Afilalo J, Mottillo S, Eisenberg MJ, Alexander KP, Noiseux N, Perrault LP, et al. Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes. 2012;5:222–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Sündermann S, Dademasch A, Praetorius J, Kempfert J, Dewey T, Falk V, et al. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardiothorac Surg. 2011;39:33–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Sündermann S, Dademasch A, Rastan A, Praetorius J, Rodriguez H, Walther T, et al. One-year follow-up of patients undergoing elective cardiac surgery assessed with the comprehensive assessment of frailty test and its simplified form. Interact CardioVasc Thorac Surg. 2011;13:119–23.CrossRefPubMedGoogle Scholar
  16. 16.
    Wilson CM, Kostsuca SR, Boura JA. Utilization of a 5-Meter Walk Test in evaluating self-selected gait speed during preoperative screening of patients scheduled for cardiac surgery. Cardiopulm Phys Ther J. 2013;24:36–43.PubMedCentralPubMedGoogle Scholar
  17. 17.
    Bagnall NM, Faiz O, Darzi A, Athanasiou T. What is the utility of preoperative frailty assessment for risk stratification in cardiac surgery. Interact CardioVasc Thorac Surg. 2013;17:398–402.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Chikwe J, Adams DH. Frailty: the missing element in predicting operative mortality. Semin Thoracic Surg. 2010;22:109–10.CrossRefGoogle Scholar
  19. 19.
    Yamakawa M, Kyo S, Yamakawa S, Ono M, Kinugawa K, Nishimura T. Destination therapy: the new gold standard treatment for heart failure patients with left ventricular assist devices. Gen Thorac Cradiovasc Surg. 2013;61:111–7.CrossRefGoogle Scholar
  20. 20.
    Dunlay SM, Park SJ, Joyce LD, Daly RC, Stulak JM, McNallan SM, et al. Frailty and outcomes after implantation of left ventricular assist device as destination therapy. J Heart Lung Transplant. 2014;33:359–65.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Chung CJ, Wu C, Jones M, Kato TS, Dam TT, Givens R, et al. Reduced handgrip strength as a marker of frailty predicts clinical outcomes in patients with heart failure undergoing ventricular assist device placement. J Cardiac Fail. 2014;20:310–5.CrossRefGoogle Scholar
  22. 22.
    Flint KM, Matlock DD, Lindenfeld J, Allen LA. Frailty and the selection of patients for destination therapy left ventricular assist device. Cir Heart Fail. 2012;5:286–93.CrossRefGoogle Scholar
  23. 23.
    Flint KM, Allen LA. Getting a grip on frailty: handgrip strength in patient selection for left ventricular assist device. J Cardiac Fail. 2014;20:316–8.CrossRefGoogle Scholar
  24. 24.
    Velanovich V, Antoine H, Swartz A, Peters D, Rubinfeld I. Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013;183:104–10.CrossRefPubMedGoogle Scholar
  25. 25.
    Nakamura K, Nakamura E, Niina K, Kojima K. Outcome after valve surgery in octogenarians and efficacy of early mobilization with early cardiac rehabilitation. Gen Thorac Cardiovasc Surg. 2010;58:606–11.CrossRefPubMedGoogle Scholar
  26. 26.
    Furukawa H, Tanemoto K. Current status and future perspectives of prosthetic valve selection for aortic valve replacement. Gen Thorac Cardiovasc Surg. 2014;62:19–23.CrossRefPubMedGoogle Scholar
  27. 27.
    Masuda M, Kuwano H, Okumura M, Amano J, Arai H, Endo S, et al. Thoracic and cardiovascular surgery in Japan during 2012. Gen Thorac Cardiovasc Surg. 2014;62:734–64.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Mack M. Frailty and aortic valve disease. J Thorac Cardiovasc Surg. 2013;145:S7–10.CrossRefPubMedGoogle Scholar
  29. 29.
    Rodes-Cabau J, Mok M. Working toward a frailty index in transcatheter aortic valve replacement. J Am Coll Cardiol Intv. 2012;5:982–3.CrossRefGoogle Scholar
  30. 30.
    Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366:1686–95.CrossRefPubMedGoogle Scholar
  31. 31.
    Stortecky S, Schoenenberger AW, Moser A, Kalesan B, Jüni P, Carrel T, et al. Evaluation of multidimensional geriatric assessment as a predictor of mortality and cardiovascular events after transcatheter aortic valve implantation. J Am Coll Cardio Intv. 2012;5:489–96.CrossRefGoogle Scholar
  32. 32.
    Green P, Woglom AE, Genereux P, Daneault B, Paradis JM, Schnell S, et al. 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.CrossRefGoogle Scholar
  33. 33.
    Green P, Cohen DJ, Genereux P, McAndrew T, Arnold SV, Alu M, et al. Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER trial). Am J Cardiol. 2013;112:700–6.PubMedCentralCrossRefPubMedGoogle Scholar
  34. 34.
    Schoenenberger AW, Stortecky S, Neumann S, Moser A, Jüni P, Carrel T, et al. Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI). Eur Heart J. 2013;34:684–92.CrossRefPubMedGoogle Scholar
  35. 35.
    Kamga M, Boland B, Cornette P, Beeckmans M, De Meester C, Chenu P, et al. Impact of frailty scores on outcome of octogenarian patients undergoing transcatheter aortic valve implantation. Acta Cardiol. 2013;68:599–606.PubMedGoogle Scholar
  36. 36.
    Puls M, Sobisiak B, Bleckmann A, Jacobshagen C, Danner BC, Hünlich M, et al. 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.CrossRefPubMedGoogle Scholar
  37. 37.
    Reynolds MR, Magnuson EA, Lei Y, Leon MB, Smith CR, Svensson LG, et al. Health-related quality of life after transcatheter aortic valve replacement in inoperable patients with severe aortic stenosis. Circulation. 2011;124:1964–72.CrossRefPubMedGoogle Scholar
  38. 38.
    Tsiouris A, Hammond ZT, Velanovick V, Hodari A, Borgi J, Rubinfeld I. A modified frailty index to assess morbidity and mortality after lobectomy. J Surg Res. 2013;183:40–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Tsiouris A, Horst HM, Paone G, Hodari A, Eichenhorn M, Rubinfeld I. Preoperative risk stratification for thoracic surgery using the American College of Surgeons National Surgical Quality Improvement Program data set: functional status predicts morbidity and mortality. J Sur Res. 2012;177:1–6.CrossRefGoogle Scholar
  40. 40.
    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.CrossRefPubMedGoogle Scholar
  41. 41.
    Nakagawa T, Chiba N, Saito M, Sakaguchi Y, Ishikawa S. Clinical relevance of decreased oxygen saturation during 6-min walk test in preoperative physiological assessment for lung cancer surgery. Gen Thorac Cardiovasc Surg. 2014;62:620–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Ferguson MK, Farnan J, Hemmerich JA, Slawinski K, Acevedo J, Small S. The impact of perceived frailty on surgeons’ estimates of surgical risk. Ann Thorac Surg. 2014;98:210–6.PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Dunne MJ, Abah U, Sacrci M. Frailty assessment in thoracic surgery. Interact CardioVasc Thorac Surg. 2014;18:667–70.CrossRefPubMedGoogle Scholar
  44. 44.
    Yamasaki M, Miyata H, Miyazaki Y, Takahashi T, Kurokawa Y, Nakajima K, et al. Perioperative therapy for esophageal cancer. Gen Thorac Cardiovasc Surg. 2014;62:531–40.CrossRefPubMedGoogle Scholar
  45. 45.
    Hodari A, Hammoud ZT, Borgi JF, Tsiouris A, Rubinfeld IS. Assessment of morbidity and mortality after esophagectomy using a modified frailty index. Ann Thorac Surg. 2013;96:1240–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Farhat JS, Velanovich V, Falvo AJ, Horst HM, Swartz A, Patton JH Jr, et al. Are the frail destined to frail? Frailty index as predictor of surgical morbidity and mortality in the elderly. J Trauma Acute Care Surg. 2012;72:1526–30.CrossRefPubMedGoogle Scholar
  47. 47.
    Dasgupta M, Rolfson DB, Stolee P, Borrie MJ, Speechley M. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2009;48:78–83.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2015

Authors and Affiliations

  1. 1.Department of Cardiovascular SurgeryKawasaki Medical SchoolKurashikiJapan

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