Title Page
Contents
STUDY 1. COMPARISON OF POSTOPERATIVE CLINICAL OUTCOMES ACCORDING TO PREOPERATIVE FRAILTY IN PATIENTS WITH LEFT VENTRICULAR ASSIST DEVICE (LVAD) AS ABRIDGE TO TRANSPLANTATION 16
ABSTRACT 17
I. INTRODUCTION 19
A. Background 19
B. Purposes of the Study 23
C. Hypotheses 24
D. The Definition of Terms 25
II. LITERATURE REVIEWS 27
A. Frailty and Clinical Outcomes in Heart Failure Patients 27
B. Preoperative Frailty Assessment according to the LVAD Strategy 35
III. METHODS 41
A. Experimental Design 41
B. Subjects and Experimental Procedures 42
C. Experimental Methods 45
D. Assessment Tools and Data Collection 46
E. Experimental Variables 50
F. Data Analysis 51
IV. RESULTS 52
A. Demographic Characteristics Stratified by Preoperative Frailty 52
B. Clinical Characteristics Stratified by Preoperative Frailty 54
C. Preoperative Functional Status Stratified by Preoperative Frailty 61
D. Postoperative Clinical Outcomes Stratified by Preoperative Frailty 65
V. DISCUSSION 75
A. Preoperative Functional Status according to Preoperative Frailty 76
B. Postoperative Clinical Outcomes according to Preoperative Frailty 83
VI. CONCLUSION 95
REFERENCES 96
APPENDIX 1. Case Report Form 110
STUDY 2. EFFECTS OF PREOPERATIVE FRAILTY ON THE POSTOPERATIVE CLINICAL OUTCOMES FOR LEFT VENTRICULAR ASSIST DEVICE (LVAD) IMPLANTATION PATIENTS IN KOREA 112
ABSTRACT 113
I. INTRODUCTION 115
A. Background 115
B. Purposes of the Study 119
C. Hypotheses 120
D. The Definition of Terms 121
II. LITERATURE REVIEWS 123
A. Preoperative Frailty Assessment 123
B. Preoperative Frailty on Clinical Outcomes After LVAD Implantation 133
III. METHODS 144
A. Experimental Design 144
B. Subjects and Experimental Procedures 145
C. Experimental Methods 148
D. Assessment Tools and Data Collection 149
E. Experimental Variables 153
F. Data Analysis 154
IV. RESULTS 155
A. Demographic Characteristics 155
B. Clinical Characteristics 157
C. Preoperative Physical and Cognitive Function 164
D. Postoperative 3-Months Clinical Outcomes 165
E. Multiple Regression Analysis for Postoperative 3-Months Clinical Outcomes 168
V. DISCUSSION 173
A. Effect of Preoperative Frailty on the Postoperative Length of Stay 175
B. Effect of Preoperative Frailty on the Postoperative Adverse Events 178
C. Effect of Preoperative Frailty on the Postoperative Ventilator Day 182
D. Effect of Preoperative Frailty on the Postoperative Readmission 184
E. Effect of Preoperative Frailty on the Postoperative Exercise Capacity 187
VI. CONCLUSION 190
REFERENCES 191
APPENDICES 13
APPENDIX 1. Left Ventricular Assist Device (LVAD) 203
APPENDIX 2. Case Report Form 206
APPENDIX 3. New York Heart Association (NYHA) Functional Classification 208
APPENDIX 4. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profiles 210
APPENDIX 5. Laboratory Test Reference 212
APPENDIX 6. Charlson Comorbidity Index 214
APPENDIX 7. Handgrip Strength Test 216
APPENDIX 8. Manual Muscle Test in Intensive Care Unit 218
APPENDIX 9. Trunk Control Test in Intensive Care Unit 220
APPENDIX 10. Mini Mental State Examination – Korea version (MMSE-K) 222
STUDY 1 9
Table 1. Frailty and Clinical Outcomes in Heart Failure Patients 30
Table 2. Preoperative Frailty Assessment according to the LVAD Strategy 38
Table 3. Independent and Dependent Variables of Study 50
Table 4. Demographic Characteristics Stratified by Preoperative Frailty 53
Table 5. Clinical Characteristics Stratified by Preoperative Frailty 56
Table 6. Preoperative Functional Status Stratified by Preoperative Frailty 62
Table 7. Postoperative Clinical Outcomes Stratified by Preoperative Frailty 67
STUDY 2 14
Table 1. Preoperative Frailty Assessment 128
Table 2. Preoperative Frailty on Clinical Outcomes After LVAD Implantation 138
Table 3. Independent and Dependent Variables of Study 153
Table 4. Demographic Characteristics 156
Table 5. Clinical Characteristic 159
Table 6. Preoperative Physical and Cognitive Function 164
Table 7. Postoperative 3-Months Clinical Outcomes 166
Table 8. Multiple Regression Analysis for Postoperative 3-Months Clinical Outcomes 170
STUDY 1 10
Figure 1. Flow Diagram of Total Experimental Procedure 44
Figure 2. Comparison of Preoperative Handgrip Strength. *p〈0.05. 63
Figure 3. Comparison of Preoperative Knee Extensor Muscle Strength. *p〈0.05. 63
Figure 4. Comparison of Preoperative Trunk Control Test. *p〈0.05. 64
Figure 5. Comparison of Preoperative MMSE-K. *p〈0.05. 64
Figure 6. Comparison of Postoperative Length of Stay. *p〈0.05. 69
Figure 7. Comparison of Postoperative Major Bleeding. *p〈0.05. 69
Figure 8. Comparison of Postoperative Major Infection. *p〈0.05. 70
Figure 9. Comparison of Postoperative Right Heart Failure. *p〈0.05. 70
Figure 10. Comparison of Postoperative Stroke. *p〈0.05. 71
Figure 11. Comparison of Postoperative Ventricular Arrhythmias. *p〈0.05. 71
Figure 12. Comparison of Postoperative Ventilator Day. *p〈0.05. 72
Figure 13. Comparison of Postoperative Time to 1st Readmission. *p〈0.05.[이미지참조] 72
Figure 14. Comparison of Postoperative 3-Months Readmission. *p〈0.05. 73
Figure 15. Comparison of Postoperative 6MWD. *p〈0.05. 73
Figure 16. Comparison of Postoperative VO₂peak. *p〈0.05. 74
STUDY 2 15
Figure 1. Experimental Design. 144
Figure 2. Flow Diagram of Total Experimental Procedure 147
Supplementary Figure 1. HVAD 204
Supplementary Figure 2. HeartMate II 204
Supplementary Figure 3. HeartMate III 205
Supplementary Figure 4. Hand Dynamometer 217
Supplementary Figure 5. Handgrip Strength Test in Intensive Care Unit 217
Supplementary Figure 6. Manual Muscle Test in Intensive Care Unit 219
Supplementary Figure 7. Trunk Control Test in Intensive Care Unit 221