Skip to main content
Erschienen in: General Thoracic and Cardiovascular Surgery 11/2023

30.03.2023 | Original Article

Impact of sarcopenia on early and mid-term outcomes of surgery for acute type A aortic dissection in octogenarians

verfasst von: Takahiro Ishigaki, Satoru Wakasa, Yasushige Shingu, Yohei Ohkawa, Akira Yamada

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 11/2023

Einloggen, um Zugang zu erhalten

Abstract

Objective

To determine the association between sarcopenia and surgical outcomes in octogenarians with acute type A aortic dissection.

Methods

We enrolled 72 octogenarians who had undergone type A aortic dissection surgery between April 2013 and March 2019. The psoas muscle index, an indexed area of the psoas muscle at the L3 level on preoperative computed tomography, was obtained as an indicator of sarcopenia. The study participants were divided into sarcopenia and non-sarcopenia groups based on the mean psoas muscle index. The postoperative outcomes were compared between the groups.

Results

The median age was 84 years (interquartile range 82–87 years), and 13 patients were male. The mean psoas muscle index was 3.53 ± 0.97 cm2/m2. Except for sex, no significant differences were observed in patients’ baseline characteristics and operative data between the two groups. The 30-day mortality rates in the sarcopenia and non-sarcopenia groups were 14% and 8%, respectively (P = 0.71), and postoperative morbidity was similar in both groups. Postoperative all-cause mortality was significantly higher in the sarcopenia group (log-rank P = 0.038), especially in patients aged 85 years or older (log-rank P < 0.01). The sarcopenia group had a lower home discharge rate than the non-sarcopenia group (21% vs. 54%, P < 0.01), and home discharge was associated with longer survival (log-rank P = 0.015).

Conclusions

All-cause mortality after emergency surgery for acute type A aortic dissection was significantly higher in octogenarians with sarcopenia than in those without, especially in patients aged 85 years or older.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation. 2006;114:2611–8.CrossRefPubMed Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation. 2006;114:2611–8.CrossRefPubMed
2.
Zurück zum Zitat Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol. 2015;66:350–8.CrossRefPubMed Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol. 2015;66:350–8.CrossRefPubMed
3.
Zurück zum Zitat Alexander KP, Anstrom KJ, Muhlbaier LH, Grosswald RD, Smith PK, Jones RH, et al. Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network. J Am Coll Cardiol. 2000;35:731–8.CrossRefPubMed Alexander KP, Anstrom KJ, Muhlbaier LH, Grosswald RD, Smith PK, Jones RH, et al. Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network. J Am Coll Cardiol. 2000;35:731–8.CrossRefPubMed
4.
Zurück zum Zitat Omura A, Matsuda H, Minami H, Nakai H, Henmi S, Murakami H, et al. Early and late outcomes of operation for acute type A aortic dissection in patients aged 80 years and older. Ann Thorac Surg. 2017;103:131–8.CrossRefPubMed Omura A, Matsuda H, Minami H, Nakai H, Henmi S, Murakami H, et al. Early and late outcomes of operation for acute type A aortic dissection in patients aged 80 years and older. Ann Thorac Surg. 2017;103:131–8.CrossRefPubMed
5.
Zurück zum Zitat Suzuki T, Asai T, Kinoshita T. Emergency surgery for acute type A aortic dissection in octogenarians without patient selection. Ann Thorac Surg. 2019;107:1146–53.CrossRefPubMed Suzuki T, Asai T, Kinoshita T. Emergency surgery for acute type A aortic dissection in octogenarians without patient selection. Ann Thorac Surg. 2019;107:1146–53.CrossRefPubMed
6.
Zurück zum Zitat Trimarchi S, Eagle KA, Nienaber CA, Rampoldi V, Jonker FH, De Vincentiis C, et al. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg. 2010;140:784–9.CrossRefPubMed Trimarchi S, Eagle KA, Nienaber CA, Rampoldi V, Jonker FH, De Vincentiis C, et al. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg. 2010;140:784–9.CrossRefPubMed
7.
Zurück zum Zitat Ikeno Y, Koide Y, Abe N, Matsueda T, Izawa N, Yamazato T, et al. Impact of sarcopenia on the outcomes of elective total arch replacement in the elderly†. Eur J Cardiothorac Surg. 2017;51:1135–41.CrossRefPubMed Ikeno Y, Koide Y, Abe N, Matsueda T, Izawa N, Yamazato T, et al. Impact of sarcopenia on the outcomes of elective total arch replacement in the elderly†. Eur J Cardiothorac Surg. 2017;51:1135–41.CrossRefPubMed
8.
Zurück zum Zitat Newton DH, Kim C, Lee N, Wolfe L, Pfeifer J, Amendola M. Sarcopenia predicts poor long-term survival in patients undergoing endovascular aortic aneurysm repair. J Vasc Surg. 2018;67:453–9.CrossRefPubMed Newton DH, Kim C, Lee N, Wolfe L, Pfeifer J, Amendola M. Sarcopenia predicts poor long-term survival in patients undergoing endovascular aortic aneurysm repair. J Vasc Surg. 2018;67:453–9.CrossRefPubMed
9.
Zurück zum Zitat Hawkins RB, Mehaffey JH, Charles EJ, Kern JA, Lim DS, Teman NR, et al. Psoas muscle size predicts risk-adjusted outcomes after surgical aortic valve replacement. Ann Thorac Surg. 2018;106:39–45.CrossRefPubMedPubMedCentral Hawkins RB, Mehaffey JH, Charles EJ, Kern JA, Lim DS, Teman NR, et al. Psoas muscle size predicts risk-adjusted outcomes after surgical aortic valve replacement. Ann Thorac Surg. 2018;106:39–45.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Okamura H, Kimura N, Tanno K, Mieno M, Matsumoto H, Yamaguchi A, et al. The impact of preoperative sarcopenia, defined based on psoas muscle area, on long-term outcomes of heart valve surgery. J Thorac Cardiovasc Surg. 2019;157:1071-1079.e3.CrossRefPubMed Okamura H, Kimura N, Tanno K, Mieno M, Matsumoto H, Yamaguchi A, et al. The impact of preoperative sarcopenia, defined based on psoas muscle area, on long-term outcomes of heart valve surgery. J Thorac Cardiovasc Surg. 2019;157:1071-1079.e3.CrossRefPubMed
11.
Zurück zum Zitat Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31.CrossRefPubMed Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31.CrossRefPubMed
12.
Zurück zum Zitat Brown JC, Harhay MO, Harhay MN. Sarcopenia and mortality among a population-based sample of community-dwelling older adults. J Cachexia Sarcopenia Muscle. 2016;7:290–8.CrossRefPubMed Brown JC, Harhay MO, Harhay MN. Sarcopenia and mortality among a population-based sample of community-dwelling older adults. J Cachexia Sarcopenia Muscle. 2016;7:290–8.CrossRefPubMed
13.
Zurück zum Zitat Xue X, Agalliu I, Kim MY, Wang T, Lin J, Ghavamian R, et al. New methods for estimating follow-up rates in cohort studies. BMC Med Res Methodol. 2017;17:155.CrossRefPubMedPubMedCentral Xue X, Agalliu I, Kim MY, Wang T, Lin J, Ghavamian R, et al. New methods for estimating follow-up rates in cohort studies. BMC Med Res Methodol. 2017;17:155.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Petermann-Rocha F, Balntzi V, Gray SR, Lara J, Ho FK, Pell JP, et al. Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2022;13:86–99.CrossRefPubMed Petermann-Rocha F, Balntzi V, Gray SR, Lara J, Ho FK, Pell JP, et al. Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2022;13:86–99.CrossRefPubMed
15.
Zurück zum Zitat Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle. 2016;7:28–36.CrossRefPubMed Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle. 2016;7:28–36.CrossRefPubMed
16.
Zurück zum Zitat Bahat G, İlhan B. Sarcopenia and the cardiometabolic syndrome: a narrative review. Eur Geriatr Med. 2016;7:220–3.CrossRef Bahat G, İlhan B. Sarcopenia and the cardiometabolic syndrome: a narrative review. Eur Geriatr Med. 2016;7:220–3.CrossRef
18.
Zurück zum Zitat De Buyser SL, Petrovic M, Taes YE, Toye KR, Kaufman JM, Lapauw B, et al. Validation of the FNIH sarcopenia criteria and SOF frailty index as predictors of long-term mortality in ambulatory older men. Age Ageing. 2016;45:602–8.CrossRefPubMed De Buyser SL, Petrovic M, Taes YE, Toye KR, Kaufman JM, Lapauw B, et al. Validation of the FNIH sarcopenia criteria and SOF frailty index as predictors of long-term mortality in ambulatory older men. Age Ageing. 2016;45:602–8.CrossRefPubMed
19.
Zurück zum Zitat Kiriya Y, Toshiaki N, Shibasaki I, Ogata K, Ogawa H, Takei Y, et al. Sarcopenia assessed by the quantity and quality of skeletal muscle is a prognostic factor for patients undergoing cardiac surgery. Surg Today. 2020;50:895–904.CrossRefPubMed Kiriya Y, Toshiaki N, Shibasaki I, Ogata K, Ogawa H, Takei Y, et al. Sarcopenia assessed by the quantity and quality of skeletal muscle is a prognostic factor for patients undergoing cardiac surgery. Surg Today. 2020;50:895–904.CrossRefPubMed
20.
Zurück zum Zitat Zuckerman J, Ades M, Mullie L, Trnkus A, Morin JF, Langlois Y, et al. Psoas muscle area and length of stay in older adults undergoing cardiac operations. Ann Thorac Surg. 2017;103:1498–504.CrossRefPubMed Zuckerman J, Ades M, Mullie L, Trnkus A, Morin JF, Langlois Y, et al. Psoas muscle area and length of stay in older adults undergoing cardiac operations. Ann Thorac Surg. 2017;103:1498–504.CrossRefPubMed
21.
Zurück zum Zitat Hata M, Sezai A, Niino T, Yoda M, Unosawa S, Furukawa N, et al. Should emergency surgical intervention be performed for an octogenarian with type A acute aortic dissection. J Thorac Cardiovasc Surg. 2008;135:1042–6.CrossRefPubMed Hata M, Sezai A, Niino T, Yoda M, Unosawa S, Furukawa N, et al. Should emergency surgical intervention be performed for an octogenarian with type A acute aortic dissection. J Thorac Cardiovasc Surg. 2008;135:1042–6.CrossRefPubMed
Metadaten
Titel
Impact of sarcopenia on early and mid-term outcomes of surgery for acute type A aortic dissection in octogenarians
verfasst von
Takahiro Ishigaki
Satoru Wakasa
Yasushige Shingu
Yohei Ohkawa
Akira Yamada
Publikationsdatum
30.03.2023
Verlag
Springer Nature Singapore
Erschienen in
General Thoracic and Cardiovascular Surgery / Ausgabe 11/2023
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-023-01932-9

Weitere Artikel der Ausgabe 11/2023

General Thoracic and Cardiovascular Surgery 11/2023 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.