Psoas Muscle Index (PMI) as a Predictor of Outcomes After Minimally Invasive Cardiac Surgery

NCT ID: NCT06571643

Last Updated: 2024-08-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Total Enrollment

25 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-09-01

Study Completion Date

2025-12-01

Brief Summary

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Sarcopenia or muscle loss and function is a component of the frailty syndrome. In this sense, frailty is becoming an important risk factor in predicting outcomes after major surgery and is defined as a geriatric syndrome of decreased reserve and resiliency to stressors that have been associated with adverse health outcomes in older adults. Despite its potentially relevant role in predicting postoperative recovery, frailty is rarely evaluated before surgery, and this is partially due to the low reliability of the most used frailty scores. Therefore, improvement in the frailty evaluation would be beneficial during the preoperative assessment of major surgeries. Sarcopenia, or the decline of skeletal muscle tissue with age, is one of the most important causes of functional decline and loss of independence in older adults and low muscle mass is a core component of frailty that has the advantage of being objectively quantifiable regardless of mobility, disability, or illness acuity. Psoas Muscle (PM) mass is an important parameter for evaluating muscle mass and has been previously correlated to frailty with a negative impact on the postoperative outcomes after major surgery and Psoas Muscle mass Index (PMI) is an easily available parameter for evaluating muscle mass and has already been demonstrated to be effective in predicting outcomes in different clinical settings. PMI has also been shown to be an effective predictor of outcomes in cardiac surgery although there are no studies specifically focusing on minimally invasive cardiac surgery. With this study, the investigators aim to investigate the relevance of PMI as a predictor of postoperative mobilisation, hospital length of stay and clinical recovery after major cardiac surgery conducted via a minimally invasive approach.

Detailed Description

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This is a prospective, controlled, observational single-centre study of patients undergoing minimally invasive heart valve surgery at the department of minimally invasive cardiac surgery of the IRCCS Galeazzi Sant'Ambrogio Hospital, in Milan (Italy).

The primary endpoint is to evaluate the role of psoas muscle index (PMI) in predicting length of stay and early mobility after heart valve surgery via a minimally invasive approach.

25 consecutive participants patients undergoing minimally invasive cardiac surgery will be assessed with a lower abdomen MRI before the surgery to evaluate the diameter of the psoas muscle and therefore assess the Psoas Muscle Index (PMI). Frailty will be evaluated using the PRISMA-7 questionnaire.

PMI value will be correlated with the main outcomes via regression methods and adjusted for covariates.

The participants will be consented to the study before the cardiac surgery operation (indexed procedure). Surgeries will include aortic, mitral and tricuspid valve operations conducted either via a mini-thoracotomy or a mini-sternotomy approach and every patient will receive routine preoperative, operative and postoperative cardiac surgery care. In addition to standard cardiac surgery clinical variables, the investigators will collect data on:

* Total intubation hours
* Total Intensive Treatment Unit (ITU) length of stay
* Total postoperative length of hospital stay
* Time between end of surgery and first mobilisation (see below)

Conditions

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Sarcopenia Heart Valve Diseases

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Interventions

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Lower Abdomen MRI

The patients will undergo a lower abdomen MRI to assess the size of the psoas muscle and derive the PMI

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Elderly patients (≥ 65 years old)
* Able to take consent
* Listed for minimally invasive cardiac surgery
* Elective and urgent procedures included
* Able to undergo MRI

Exclusion Criteria

* Full median sternotomy approach
* Emergency procedures
* Unable to take consent
* Unable to undergo MRI
Minimum Eligible Age

65 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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I.R.C.C.S Ospedale Galeazzi-Sant'Ambrogio

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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I.R.C.C.S Ospedale Galeazzi-Sant'Ambrogio

Milan, , Italy

Site Status

Countries

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Italy

Central Contacts

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Vito D Bruno, MD, PhD

Role: CONTACT

0283500010 ext. 6748

References

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Benedek Z, Todor-Boer S, Kocsis L, Bauer O, Suciu N, Coros MF. Psoas Muscle Index Defined by Computer Tomography Predicts the Presence of Postoperative Complications in Colorectal Cancer Surgery. Medicina (Kaunas). 2021 May 11;57(5):472. doi: 10.3390/medicina57050472.

Reference Type BACKGROUND
PMID: 34064607 (View on PubMed)

Bruno VD, Zakkar M. Psoas muscle index: a novel instrument in planning the treatment of severe aortic stenosis in frail patients. J Thorac Dis. 2018 Nov;10(Suppl 33):S4156-S4158. doi: 10.21037/jtd.2018.10.80. No abstract available.

Reference Type BACKGROUND
PMID: 30631580 (View on PubMed)

Hawkins RB, Mehaffey JH, Charles EJ, Kern JA, Lim DS, Teman NR, Ailawadi G. Psoas Muscle Size Predicts Risk-Adjusted Outcomes After Surgical Aortic Valve Replacement. Ann Thorac Surg. 2018 Jul;106(1):39-45. doi: 10.1016/j.athoracsur.2018.02.010. Epub 2018 Mar 9.

Reference Type BACKGROUND
PMID: 29530777 (View on PubMed)

Mamane S, Mullie L, Piazza N, Martucci G, Morais J, Vigano A, Levental M, Nelson K, Lange R, Afilalo J. Psoas Muscle Area and All-Cause Mortality After Transcatheter Aortic Valve Replacement: The Montreal-Munich Study. Can J Cardiol. 2016 Feb;32(2):177-82. doi: 10.1016/j.cjca.2015.12.002. Epub 2015 Dec 9.

Reference Type BACKGROUND
PMID: 26821840 (View on PubMed)

Okamura H, Kimura N, Tanno K, Mieno M, Matsumoto H, Yamaguchi A, Adachi H. The impact of preoperative sarcopenia, defined based on psoas muscle area, on long-term outcomes of heart valve surgery. J Thorac Cardiovasc Surg. 2019 Mar;157(3):1071-1079.e3. doi: 10.1016/j.jtcvs.2018.06.098. Epub 2018 Jul 27.

Reference Type BACKGROUND
PMID: 30139644 (View on PubMed)

Paknikar R, Friedman J, Cron D, Deeb GM, Chetcuti S, Grossman PM, Wang S, Englesbe M, Patel HJ. Psoas muscle size as a frailty measure for open and transcatheter aortic valve replacement. J Thorac Cardiovasc Surg. 2016 Mar;151(3):745-751. doi: 10.1016/j.jtcvs.2015.11.022. Epub 2015 Nov 21.

Reference Type BACKGROUND
PMID: 26896357 (View on PubMed)

Raiche M, Hebert R, Dubois MF. PRISMA-7: a case-finding tool to identify older adults with moderate to severe disabilities. Arch Gerontol Geriatr. 2008 Jul-Aug;47(1):9-18. doi: 10.1016/j.archger.2007.06.004. Epub 2007 Aug 27.

Reference Type BACKGROUND
PMID: 17723247 (View on PubMed)

Rodge GA, Goenka U, Jajodia S, Agarwal R, Afzalpurkar S, Roy A, Goenka MK. Psoas Muscle Index: A Simple and Reliable Method of Sarcopenia Assessment on Computed Tomography Scan in Chronic Liver Disease and its Impact on Mortality. J Clin Exp Hepatol. 2023 Mar-Apr;13(2):196-202. doi: 10.1016/j.jceh.2022.12.002. Epub 2022 Dec 9.

Reference Type BACKGROUND
PMID: 36950487 (View on PubMed)

Walston JD. Sarcopenia in older adults. Curr Opin Rheumatol. 2012 Nov;24(6):623-7. doi: 10.1097/BOR.0b013e328358d59b.

Reference Type BACKGROUND
PMID: 22955023 (View on PubMed)

Xu JY, Li C, Zhang H, Liu Y, Wei JM. Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy. Risk Manag Healthc Policy. 2020 Jul 9;13:761-770. doi: 10.2147/RMHP.S257677. eCollection 2020.

Reference Type BACKGROUND
PMID: 32753989 (View on PubMed)

Wu XL, Shen J, Danzeng CD, Xu XS, Cao ZX, Jiang W. CT psoas calculations on the prognosis prediction of emergency laparotomy: a single-center, retrospective cohort study in eastern Asian population. World J Emerg Surg. 2022 Jun 3;17(1):31. doi: 10.1186/s13017-022-00435-x.

Reference Type BACKGROUND
PMID: 35655215 (View on PubMed)

Yamashita M, Kamiya K, Matsunaga A, Kitamura T, Hamazaki N, Matsuzawa R, Nozaki K, Tanaka S, Nakamura T, Maekawa E, Masuda T, Ako J, Miyaji K. Prognostic Value of Psoas Muscle Area and Density in Patients Who Undergo Cardiovascular Surgery. Can J Cardiol. 2017 Dec;33(12):1652-1659. doi: 10.1016/j.cjca.2017.10.009. Epub 2017 Oct 16.

Reference Type BACKGROUND
PMID: 29173605 (View on PubMed)

Zuckerman J, Ades M, Mullie L, Trnkus A, Morin JF, Langlois Y, Ma F, Levental M, Morais JA, Afilalo J. Psoas Muscle Area and Length of Stay in Older Adults Undergoing Cardiac Operations. Ann Thorac Surg. 2017 May;103(5):1498-1504. doi: 10.1016/j.athoracsur.2016.09.005. Epub 2016 Nov 15.

Reference Type BACKGROUND
PMID: 27863730 (View on PubMed)

Other Identifiers

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PsoMICS L2097

Identifier Type: -

Identifier Source: org_study_id

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