Prognostic Role of the Modified Frailty Index in Octogenarians Undergoing Minimally Invasive Aortic Valve Replacement

Area of Science:

• Cardiology
• Geriatric Surgery
• Health Outcomes Research

Background:

• Frailty is a critical factor influencing surgical risk in elderly patients.
• Aortic valve replacement (AVR) in octogenarians requires precise risk stratification.
• Minimally invasive AVR offers benefits but necessitates careful patient selection.

Purpose of the Study:

• To assess the prognostic capability of the modified Frailty Index (mFI) in octogenarians undergoing minimally invasive AVR.
• To improve risk stratification and guide surgical decision-making in this vulnerable population.
• To correlate mFI with early and long-term outcomes after AVR.

Main Methods:

• Retrospective analysis of 67 patients aged ≥ 80 years undergoing isolated minimally invasive AVR.
• Preoperative calculation of the mFI using standardized clinical variables.
• Evaluation of 30-day mortality, perioperative complications, and long-term survival using ROC curves, Kaplan-Meier, and Cox regression.

Main Results:

• The mFI demonstrated strong prognostic accuracy for both mortality and complications.
• An mFI > 0.455 predicted 30-day mortality with high sensitivity and specificity (AUC = 0.888).
• An mFI > 0.273 predicted perioperative complications (AUC = 0.818), and higher scores predicted long-term mortality.

Conclusions:

• The mFI is a simple, reproducible tool for predicting outcomes in very elderly patients undergoing minimally invasive AVR.
• Integrating frailty assessment into preoperative evaluations can enhance patient selection.
• Prioritizing physiological status over chronological age may optimize surgical outcomes.