Heart valve surgery and the obesity paradox: A systematic review

EL‐Andari, Ryaan; Bozso, Sabin J.; Kang, Jimmy J H; Bedard, A; Adams, Corey; Wang, Wei; Nagendran, Jeevan

doi:10.1111/cob.12506

Cited by 9 publications

(10 citation statements)

References 71 publications

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“…Evidence from clinical cohorts of patients with cardiovascular disease suggests that the obesity paradox lies in the fact that overweight and obese patients with cardiovascular disease appear to have a better short-term and long-term prognosis than lean patients. In recent years, several studies have suggested that obese patients may be at no different risk for cardiac surgery than non-obese patients, particularly in terms of mortality [5][6][7]. This study found that overweight and obese patients had a signi cantly increased risk of CSA-AKI after surgery, in contrast to the cardioobesity paradox, consistent with previous studies [28,29].…”

Section: Discussionsupporting

confidence: 89%

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Impact of Body Mass Index on Clinical Outcomes after Robotic Cardiac Surgery in Da Vinci: is There an Obesity Paradox?

Ding

Chen

et al. 2022

Preprint

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Objective：To analyze the safety and efficacy of Da Vinci robotic cardiac surgery, to investigate the effect of body mass index (BMI) on postoperative clinical outcomes, and to explore the postoperative obesity paradox. Methods：The data of 146 patients who underwent cardiac surgery under Da Vinci robotic cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed, and their demographic data and related clinical data were statistically analyzed. The mean age was (42.88±13.01) years, 55 (37.67%) were male and 91 (62.33%) were female. Patients were divided into 3 groups according to preoperative BMI: lean group (BMI<18.5 kg/m2; n=17; 11.64%), normal group (18.5 kg/m2≤BMI<23.9 kg/m2; n=81; 55.48%), and overweight and obese group (BMI≥24 kg/m2; n=48; 32.88%). Multivariate analysis was performed to compare clinical outcomes across BMI groups. Results：Preoperative data in different BMI groups showed that there were statistically significant differences in gender, height, weight, body surface area (BSA), diabetes, left atrial anteroposterior diameter (LAD), triglyceride (TG), high-density lipoprotein (HDL), and lymphocyte count (LY) (all P<0.05). Postoperative clinical outcomes showed that the risk of cardiac surgery-associated acute kidney injury (CSA-AKI) was significantly increased in the overweight and obese groups (P=0.021), and further multivariate binary logistic regression analysis suggested that preoperative TG (OR 1.772, 95%CI 1.068-2.942,P=0.027) and operation time ≥ 300 min (OR 3.823, 95%CI 1.098-13.308,P=0.035) were independent risk factors for postoperative CSA-AKI. Conclusion：Overweight and obese cardiac surgery is prone to CSA-AKI, which does not support the obesity paradox; preoperative TG and operation time≥300 min are independent risk factors for postoperative CSA-AKI.

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Section: Discussionsupporting

confidence: 89%

“…In recent years, several studies have suggested that obese patients may be at no different risk for cardiac surgery than non-obese patients, particularly in terms of mortality [5][6][7]. However, these studies are limited by single-center, small-sample studies.…”

Section: Introductionmentioning

confidence: 99%

Impact of Body Mass Index on Clinical Outcomes after Robotic Cardiac Surgery in Da Vinci: is There an Obesity Paradox?

Ding

Chen

et al. 2022

Preprint

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“…On the contrary, BMI was inversely correlated with mortality. This latter concept is known as 'obesity paradox' and has been described already by others (13,14).…”

Section: Discussionmentioning

confidence: 76%

“…Visceral obesity causes a decrease in insulinmediated glucose uptake, insulin resistance and ultimately endothelial dysfunction (3,5). Nonetheless, waist circumference is seldom measured in the cardiac surgery context, and most studies that investigated the obesity paradox have considered the BMI as measure of obesity, rather than waist circumference (14).…”

Section: Discussionmentioning

confidence: 99%

The influence of metabolic syndrome in heart valve intervention. A multi-centric study.

Moscarelli

Paparella

Angelini

et al. 2022

Preprint

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Background. The effect of metabolic syndrome (MetS), defined as insulin resistance along with two or more of: obesity, atherogenic dyslipidaemia and elevated blood pressure, on post-operative complications after isolated heart valve intervention remains controversial. We hypothesized that MetS may negatively influence the post-operative course in these patients. Methods. Patients from 10 cardiac units who underwent isolated valve intervention (mitral ± tricuspid repair/replacement (MVS) or aortic valve replacement (SAVR), or transcatheter aortic valve replacement (TAVR) were included. MetS was defined according to the WHO criteria. Primary outcome was in-hospital mortality and overall post-operative length of stay. Relevant post-operative complications were also recorded. Results. From 2010 to 2019, 17283 patients underwent valve intervention. The MVS, SVAR and TAVR accounted for the 39.4%, 48.2% and 12.3% respectively of the whole. MetS compared to no-MetS was associated to higher mortality in the MVS group (6.5% vs. 2%, p<0.001), but not in the SAVR and TAVR group. In both surgical cohorts, MetS was associated with increased complications including red blood cells transfusion, renal failure, mechanical ventilation time, intensive care and overall post-operative length of stay (11 (9) vs. 10 (6), p<0.001 and 10 (6) vs. 10(5) days, p=0.002, MVS and SAVR)). No differences were found in the TAVR cohort, with similar mortality and complications. Conclusion. MetS was associated to more post-operative complications, with higher mortality in the MVS group. In the TAVR cohort, post-operative complications and mortality rate did not differ between patients with and without MetS, however length of stay was longer in the MetS group.

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“…This latter concept is known as "obesity paradox" and has been described already by others. 12,13 Nevertheless, there are two important considerations to be made for "obesity": the first is that not always obesity is synonymous of MetS since there are so-called metabolically healthy obese (MHO) individuals with high level of insulin sensitivity without systemic hypertension and atherogenic dyslipidaemia and other features of MetS. 14,15 A survey analysis, suggested that MHO may account for a significant percentage of obese population.…”

Section: Discussionmentioning

confidence: 99%

The influence of metabolic syndrome in heart valve intervention. A multi‐centric study

Moscarelli¹,

Paparella

Angelini

et al. 2022

Journal of Cardiac Surgery

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Background The effect of metabolic syndrome (MetS), defined as insulin resistance along with two or more of: obesity, atherogenic dyslipidaemia and elevated blood pressure, on postoperative complications after isolated heart valve intervention remains controversial. We hypothesized that MetS may negatively influence the postoperative course in these patients. Methods Patients from 10 cardiac units who underwent isolated valve intervention (mitral ± $\pm $ tricuspid repair/replacement (mitral valve surgery [MVS]) or surgical aortic valve replacement (SAVR), or transcatheter aortic valve replacement (TAVR) were included. MetS was defined according to the World Health Organization criteria. Primary outcome was in‐hospital mortality and overall postoperative length of stay (LOS). Relevant postoperative complications were also recorded. Results From 2010 to 2019, 17,283 patients underwent valve intervention. The MVS, SVAR, and TAVR accounted for the 39.4%, 48.2%, and 12.3% respectively of the whole. MetS compared to no‐MetS was associated to higher mortality in the MVS group (6.5% vs. 2%, p < .001), but not in the SAVR and TAVR group. In both surgical cohorts, MetS was associated with increased complications including red blood cells transfusion, renal failure, mechanical ventilation time, intensive care and overall postoperative LOS (11 (9) vs. 10 (6), p < .001 and 10 (6) versus 10 (5) days, p = .002, MVS and [SAVR]). No differences were found in the TAVR cohort, with similar mortality and complications. Conclusion MetS was associated to more postoperative complications, with higher mortality in the MVS group. In the TAVR cohort, postoperative complications and mortality rate did not differ between patients with and without MetS, however LOS was longer in the MetS group.

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Heart valve surgery and the obesity paradox: A systematic review

Cited by 9 publications

References 71 publications

Impact of Body Mass Index on Clinical Outcomes after Robotic Cardiac Surgery in Da Vinci: is There an Obesity Paradox?

Impact of Body Mass Index on Clinical Outcomes after Robotic Cardiac Surgery in Da Vinci: is There an Obesity Paradox?

The influence of metabolic syndrome in heart valve intervention. A multi-centric study.

The influence of metabolic syndrome in heart valve intervention. A multi‐centric study

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