title: Impact of sarcopenia on the outcomes of elective total arch replacement in the elderly†.
abstract: OBJECTIVE
  The purpose of this study was to identify the cut-off value of sarcopenia based on the psoas muscle area index and evaluate early and late outcomes following elective total arch replacement in the elderly.
  
  
  METHODS
  Sarcopenia was assessed by the psoas muscle area index [defined as the psoas muscle area at the L3 level on computed tomography (cm 2 )/body surface area (m 2 )]. The cut-off value for sarcopenia was defined as > 2 standard deviations below the mean psoas muscle area index value obtained from 464 normal control patients. Between October 1999 and July 2015, 266 patients who were ≥ 65 years and had undergone psoas muscle area index measurement underwent elective total arch replacement. These patients were classified into the sarcopenia (Group S, n  = 81) and non-sarcopenia (Group N, n  = 185) groups.
  
  
  RESULTS
  The mean age was 76.2 ± 5.6 years in Group S and 75.7 ± 5.7 years in Group N ( P  = 0.553). Hospital mortality was 3.7% (3/81) in Group S and 2.2% (4/185) in Group N ( P  = 0.483). Mean follow-up was 48.3 ± 38.7 months. Five-year survival was significantly worse in Group S (S: 63.2 ± 6.6% vs N: 88.7 ± 2.6%, P  < 0.001). A multivariable Cox proportional hazard analysis showed that sarcopenia significantly predicted poor survival (hazard ratio 2.59; 95% confidence interval 1.27-5.29; P  = 0.011).
  
  
  CONCLUSIONS
  Sarcopenia did not predict hospital death following total arch replacement, but it was negatively associated with overall survival. Sarcopenia can be an additional risk factor to estimate the outcomes of thoracic aortic surgery.
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ikeno
authors.affiliation: Division of Radiology, Kobe University, Kobe, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Koide
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Abe
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsueda
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Izawa
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamazato
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Miyahara
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Nomura
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sato
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Matsumori
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Division of Emergency, Hyogo Emergency Medical Center, Kobe, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ishihara
authors.affiliation: Division of Emergency, Hyogo Emergency Medical Center, Kobe, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nakayama
authors.affiliation: Division of Radiology, Kobe University, Kobe, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Sugimoto
authors.affiliation: Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D000073496:Frailty; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D016658:Psoas Muscles / Q000503:physiopathology; D012086:Reoperation; D018570:Risk Assessment; D055948:Sarcopenia / Q000453:epidemiology / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aortic surgery; Frailty; Preoperative risk assessment; Sarcopenia; Total arch replacement