Correlation between frailty status, surgical access, and outcomes in older adults with valvular heart disease undergoing cardiac surgery

Frailty is not routinely assessed nor incorporated into the Euroscore II, and evidence on minimally invasive cardiac surgery (MICS) in older frail adults remains limited. We evaluated whether frailty assessment improves the prognostic performance of the Euroscore II and whether MICS provides benefits in frail patients. Patients aged ≥70 years undergoing valve surgery were assessed for frailty preoperatively. The primary endpoint was the composite of all-cause death or cardiovascular hospitalization at 1 year; the secondary endpoint was 1-year all-cause mortality. A total of 568 patients were included (median age 76 years; median Euroscore II 2.3); 65.3% underwent elective surgery, and 63.4% MICS. For the primary endpoint, the Edmonton Frailty Scale (EFS) provided the greatest improvement when added to Euroscore II (Harrell’s C + 0.054, p < 0.05), followed by the Clinical Frailty Scale (+0.013, p < 0.05). For mortality, EFS showed the largest gain (+0.057, p < 0.05), followed by the Essential Frailty Toolset (+0.011, p < 0.05). In frail patients, MICS was protective for mortality but not for the composite endpoint. Frailty assessment, particularly EFS, improves risk stratification, and MICS may reduce mortality in frail older adults.