A Meta-Analysis on the Impact of High BMI in Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract

Background: A paradoxical association of obesity with lower risk of transcatheter aortic valve replacement (TAVR) outcomes has been reported. We aimed to systematically review the literature and compare TAVR-related morbidity and mortality among individuals with overweight or obesity and their peers with normal body mass index (BMI). Methods: PubMed and Embase databases were systematically searched for studies reporting TAVR outcomes in different BMI groups. Separate meta-analyses were conducted for studies reporting hazard ratios (HR) and odds ratios/relative risks. Short- and mid-/long-term outcomes were examined. Results: 26 studies with a total of 74,163 patients were included in our study. Overweight was associated with lower risk of short-term mortality (HR: 0.77; 95% CI: 0.60–0.98) and mid-/long-term mortality (HR: 0.79; 95% CI: 0.70–0.89). Obesity was associated with lower risk for mid-/long-term mortality (HR: 0.79; 95% CI: 0.73–0.86), but no difference was observed in short-term mortality, although a trend was noted (HR: 0.87l 95% CI: 0.74–1.01). Individuals with obesity demonstrated an association with higher odds of major vascular complications (OR: 1.33; 95% CI: 1.05–1.68). Both overweight (OR: 1.16; 95% CI: 1.03–1.30) and obesity (OR: 1.26; 95% CI: 1.06–1.50) were associated with higher likelihood for receiving permanent pacemakers after TAVR. Conclusion: Individuals with overweight and obesity were associated with lower mortality risk compared to those with normal BMI but with higher likelihood of major vascular complications and permanent pacemaker implantation after TAVR.

Obesity and Transcatheter Aortic Valve Replacement

“…The existing literature indicates that the incidence of vascular complications in this demographic ranges from 10% to 16% [ 27 , 28 , 29 ]. Our prior research corroborates this, revealing higher odds of major vascular complications (OR: 1.33; 95%CI: 1.05–1.68) in patients with obesity [ 20 ]. While the transfemoral (TF) approach is predominantly utilized in TAVR procedures due to its minimally invasive nature, the management of femoral vascular access and hemostasis in patients with obesity is challenging due to their unique anatomical characteristics.…”

“…We previously conducted a systematic review and meta-analysis to further explore the relationship between baseline obesity and mortality as well as the periprocedural outcomes after TAVR [ 20 ]. Here, we present an updated, comprehensive review that integrates the most recent and pertinent studies on this topic to the best of our knowledge.…”