Sarcopenia and Mid-Term Outcomes after Fenestrated-Branched Endovascular Aortic Repair
Fernando Motta, MD, Corey A. Kalbaugh, PhD, MS, Paula D. Strassle, MSPH, William A. Marston, MD, Jason R. Crowner, MD, Luigi Pascarella, MD, Katharine L. McGinigle, MD, MPH, Martyn D. Knowles, MD, RPVI, Mark A. Farber, MD.
University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.
Objectives: To evaluate the association of sarcopenia on outcomes of patients with a complex aortic aneurysm (CAA) treated with fenestrated-branched endovascular aortic repair (F-BEVAR).
Methods: We conducted a retrospective analysis of a prospectively maintained database of patients with CAA that underwent F-BEVAR (July 2012 - April 2018). Sarcopenia was defined as the sex-stratified lowest quartile of psoas muscle index (PMI: mm2/m2). Outcomes measured include early(mortality and major adverse events[MAE]) the incidence of mid-term(mortality, complications, and re-intervention). Fisher’s exact and Wilcoxon tests assessed differences in patient characteristics and the association between sarcopenia and 30-day outcomes. Kaplan-Meier curves and Cox proportional hazard regression evaluated the effect of sarcopenia on mid-term outcomes.
Results. We identified 258 patients that met inclusion criteria. Sarcopenia was defined as <587 mm2/m2 in males and <458 mm2/m2 in females. Sixty-four (25%) patients were classified as having sarcopenia (median age=76 years; 73% male). Comparing patient demographics, only median baseline age was statistically significant (76 years [sarcopenia] vs. 71 years [no sarcopenia], p=.001). The most common cardiovascular risk factor was hypertension. There were no differences in peri-operative variables when comparing the sarcopenia and no-sarcopenia groups, including median operative time (268 min vs. 243 min, p=.06), volumes of contrast used (86 ml vs. 85 ml, p=.81), or estimated blood loss (350 ml vs. 275 ml, p=.05). The overall mortality rate and occurrence of MAE were 2.3%(6/258) and 13.5%(35/258), respectively. Sarcopenia was not associated with increased risks for 30-day mortality or adverse events. The median follow-up time was 715 days (IQR: 296, 1108). Sarcopenia was not associated with increased risk for aortic complications(p=0.81), medical complications(p=0.11) or re-intervention(p=0.16); however, the 4-year all-cause age-adjusted mortality was significantly higher among patients with low PMI(Adjusted HR: 1.78 [95% CI 1.01, 3.12], p=.04).
Conclusions: The presence of sarcopenia was not associated with increased mortality or occurrence of MAE in the early postoperative period of patients with CAA undergoing F-BEVAR. However, patients with sarcopenia had a higher mortality during follow-up out to 4 years, even when adjusted for age. The presence of sarcopenia might impact patient selection along with other risk factors, when considering patients for endovascular repair of CAA. Multi-institutional studies with a larger patient population may help better define and validate our results.
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