Preoperative Sarcopenia Portends Worse Outcomes After Descending Thoracic Aortic Aneurysm Repair.

BACKGROUND: Sarcopenia may be an indicator of frailty. We used the total psoas area index (TPAI) to identify sarcopenia and evaluated the effect of preoperative TPAI on outcomes after descending thoracic aortic aneurysm (DTAA) repair.

METHODS: Patients with DTAA between 2007 and 2015 who were undergoing thoracic endovascular aortic repair (TEVAR) and open surgical repair (OSR) with available preoperative imaging were analyzed. Sarcopenia was defined as TPAI <6.5cm2 /m2 . An adverse event was defined as the composite endpoint of three or more multisystem complications, discharge to other than home, or death within 30 days.

RESULTS: A total of 282 of 386 DTAA repairs had imaging available for TPAI measurements; 71 of 282 (25%) patients underwent TEVAR, and 211 of 282 (75%) underwent OSR. Preoperative sarcopenia was similar in the two groups (OSR, 57% vs TEVAR, 48%, p = 0.188). Risk factors for sarcopenia were age >70 years, female sex, and large body surface area, whereas heritable thoracic aortic disease was a protective factor. OSR-treated patients with sarcopenia were older compared with patients without sarcopenia (p < 0.001), whereas TEVAR-treated patients had a similar age category distribution (p = 0.187). Patients with sarcopenia had significantly increased adverse events compared with patients who did not have sarcopenia in both groups (sarcopenia-TEVAR, 41% vs nonsarcopenia-TEVAR, 16%, p = 0.020; sarcopenia-OSR, 49% vs nonsarcopenia-OSR, 32%, p = 0.012). Determinants of long-term mortality were increasing age (parameter estimate [PE], 0.06, p < 0.001), TPAI as a decreasing linear function (PE, 0.36, p = 0.003), OSR (PE, 2.92, p = 0.003), and interaction between OSR and TPAI (PE, -0.34, p = 0.010). The interaction term showed that OSR increases long-term mortality risk in more sarcopenic patients.

CONCLUSIONS: Preoperative sarcopenia significantly correlated with postoperative adverse events and long-term mortality after DTAA repair. If anatomically feasible, TEVAR should be considered in sarcopenic patients.