The Impact of the Clinical Frailty Scale on Prosthesis Selection and Early Mortality in Elderly Patients Undergoing Aortic Valve Replacement

Introduction: This study explored the impact of the Clinical Frailty Scale on prosthesis selection and early postoperative outcomes in elderly patients undergoing surgical aortic valve replacement. Materials and Method: In this retrospective cohort study conducted at a single center, patients aged ≥ 65 years who underwent isolated aortic valve replacement between January 2023 and January 2025 were examined. The Clinical Frailty Scale was used to evaluate preoperative frailty and categorize patients into three frailty levels. Data on implanted valves (mechanical, conventional bioprosthesis, and sutureless bioprosthesis), operative details, and 30-day mortality were collected. Multivariate regression models were used to identify significant associations. Results: A total of 122 patients were included in the study. Patients with higher Clinical Frailty Scale scores were more likely to receive sutureless valves (p<0.001). Clinical Frailty Scale was a moderate predictor of early mortality, with an odds ratio of 3.66 and 95% confidence interval of 1.31–10.18 (p = 0.010), outperforming EuroSCORE II in predictive accuracy (AUC 0.71 compared to 0.63). Patients with sutureless valves had shorter intensive care unit and hospital stays (p<0.001), whereas complications remained consistent across the valve types. A weak but significant positive correlation was observed between prosthesis size/ body surface area ratio and 30-day mortality (Spearman’s ρ=0.186; p=0.040). Conclusion: The Clinical Frailty Scale is a significant indicator of valve selection and prediction of early postoperative mortality in elderly patients undergoing aortic valve replacement. Incorporating frailty evaluation into presurgery planning could improve outcomes in this at-risk group.