CNS Outcomes in Patients with Frailty Undergoing Coronary Artery Bypass Grafting and Heart Valve Surgical Procedures

Abstract

Context: Frailty, which is common among elderly patients undergoing cardiac surgery, is associated with an increased risk of adverse central nervous system (CNS) outcomes, including stroke, delirium, and other cerebrovascular complications. Objectives: This meta-analysis aimed to clarify the impact of frailty on these outcomes in patients undergoing coronary artery bypass grafting (CABG) and heart valve surgeries. Methods: We performed a systematic search in PubMed, Scopus, and Web of Science for studies published up to October 2024 that reported CNS outcomes according to frailty status. Pooled effect sizes and odds ratios (ORs) for stroke, delirium, transient ischemic attack (TIA), and cerebrovascular complications were calculated. Results: Across 19 studies comprising 2,357,446 patients, frail patients exhibited significantly higher rates of CNS events (5.05%) compared to non-frail patients (1.81%, P < 0.05). Stroke and delirium were notably more common in frail patients, with delirium showing an OR of 3.94. No significant difference was observed for TIA, but cerebrovascular complications were more frequent in frail patients. Outcomes differed by surgery type, with higher rates observed after heart valve procedures compared to CABG. Conclusions: Frailty is strongly associated with increased CNS complications in cardiac surgery patients, underscoring the importance of routine frailty assessments and tailored care strategies.