Abstract
Sarcopenia is an objective marker of poor outcome following cardiac surgery through median sternotomy. However, the clinical impact of sarcopenia after minimally invasive cardiac surgery (MICS) has not been well established. This study aimed to analyze the influence of sarcopenia on the early and late outcomes following MICS. We retrospectively examined 1248 patients who underwent MICS via right mini-thoracotomy or upper sternotomy between February 2009 and April 2020. Patients older than 65 years who underwent preoperative computed tomography were enrolled. Sarcopenia was defined as the lowest sex-specific quartile of the body surface area adjusted psoas muscle area. The early operative and late survival outcomes were compared, and the predictor of late composite outcome was analyzed using Cox proportional regression model. Early and late composite outcomes in both groups were also compared. A total of 367 patients were classified into the sarcopenia (n=92) or non-sarcopenia (n=275) group. Patients in the sarcopenia group were older, and had lower preoperative hemoglobin and albumin levels. They had higher estimated surgical mortality, but similar early mortality and major morbidity. The survival and late composite outcome were comparable between the two groups. Sarcopenia was neither an independent predictor of late death nor a composite outcome in the multivariable model. After MICS, patients with sarcopenia displayed comparable perioperative outcomes and survival. The clinical impact of sarcopenia on postoperative outcomes might be alleviated by MICS and early recovery protocol after MICS. MICS could be a reasonable approach for elderly patients with sarcopenia.
Highlights
Recent studies have reported that patients with sarcopenia who undergo heart surgery through the median sternotomy demonstrate lower survival rates and higher complication rates.[1,2] sarcopenia is associated with poor prognosis after cardiac surgery with full sternotomy,[1,3] the impact of sarcopenia in cases of minimally invasive cardiac surgery (MICS)is not yet well known
MICS may mitigate the impact of sarcopenia through its sternal preserving effect and can be a reasonable approach for elderly patients with sarcopenia
The patients in the lowest sex-specific quartile of the psoas muscle area (PMA) index were classified into the sarcopenia group
Summary
This is partly attributable to the lack of appropriate data because MICS had been prudently performed among older adult patients under various precautions. The relatively longer cardiopulmonary bypass (CPB) and cross-clamp times of MICS hindered the general application of MICS in older adult patients with sarcopenia.[4]. Sarcopenia is characterized by loss of skeletal muscle mass in older adults[1,5] and can be related to malnutrition, low levels of physical activity, and various chronic diseases.[5,6] These vulnerable general conditions increase the incidence of adverse postoperative outcomes.[3] The intensive care unit (ICU) stay can be prolonged, further leading to a decrease muscle mass as part of a vicious cycle.[7,8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
