Figure 1.

Effect of surgical stress and optimization measures above functional status trajectories in healthy and frail patients. Following the stress of cardiac surgery healthy individuals (green line) suffer from a acute worsening of functional status, that promptly return to baseline during post-operative period. Frail individuals (red line) are characterized by a compromised baseline functional capacity. Similarly to healthy individuals, functional capacity is further reduced after surgery. As frail patients are not able to face such stressing factor, they could not be able to return to baseline functional capacity during post-operative period. This circumstance can compromise long-term outcome and ultimately the net result of the surgical procedure. Functional capacity trajectory could be modified by pre-operative, intra-operative and post-operative specific intervention (dashed red line), whose aim is to improve baseline conditions and to reduce the stressful burden of cardiac surgery.