Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement

McInerney, Angela; Tirado‐Conte, Gabriela; Rodés‐Cabau, Josep; Campelo‐Parada, Francisco; Soto, Jose D. Tafur; Barbanti, Marco; Muñoz-García, Érika; Arif, Mobeena; Lopez, Diego; Toggweiler, Stefan; Pylko, Anna; Sevilla, Teresa; Compagnone, Miriam; Regueiro, Ander; Serra, Viçent; Carnero, Manuel; Oteo, Juan Francisco; Rivero, Fernando; Ribeiro, Henrique Barbosa; Guimarães, Leonardo; Matta, Anthony; Echavarría, Natalia Giraldo; Valvo, Roberto; Moccetti, Federico; Muñoz-García, Antonio J.; López-País, Javier; Blanco, Bruno García del; Borges, Diego Carter Campanha; Dumont, Éric; Gonzalo, Nieves; Criscione, Enrico; Dąbrowski, M; Alfonso, Fernándo; Cheema, Asim N.; Amat‐Santos, Ignacio J.; Saia, Francesco; Escaned, Javier; Nombela‐Franco, Luis

doi:10.1161/jaha.120.019051

Cited by 15 publications

(16 citation statements)

References 41 publications

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“…Two studies found BMI as inversely associated to mortality, while visceral adiposity as independent risk factor for postoperative mortality. 20,21 Those findings confirm the suboptimal accuracy of BMI as trait for MetS. Opposite to the surgical group, in our series we found that MetS was not associated with worst postoperative outcomes in the TAVR subgroup.…”

Section: Discussionsupporting

confidence: 82%

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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Section: Discussionsupporting

confidence: 82%

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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“…Some studies investigated the effect of specific risk factors (i.e., diabetes / obesity) (19) in patients undergoing TAVR, but none focused on MetS. Two studies found BMI as inversely associated to mortality, while visceral adiposity as independent risk factor for post-operative mortality (20,21). Those findings confirm the suboptimal accuracy of BMI as trait for MetS.…”

Section: Discussionmentioning

confidence: 98%

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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“…Over recent years, TAVI has been used as an alternative to surgical aortic valve replacement for patients deemed to be at high surgical risk. Studies, however, have demonstrated that TAVI in the younger morbidly obese patient group compared with normal‐weight counterparts is associated with an increased risk of major vascular complications (6.6% vs. 4.3%; p = .0430) and a lower device success rate (84.4% vs. 88.1%; p = .038) 75 . When comparing TAVI to an open approach, a retrospective analysis carried out in 284 obese patients found that there was no difference in mortality at 30 days (5.2% vs. 3.2%; p = .41) and the 5‐year survival was higher in the surgical aortic valve group compared with the TAVI group (71.8% vs. 52.8%; p = .0046) 64 .…”

Section: Methodsmentioning

confidence: 99%

“…Studies, however, have demonstrated that TAVI in the younger morbidly obese patient group compared with normal-weight counterparts is associated with an increased risk of major vascular complications (6.6% vs. 4.3%; p = .0430) and a lower device success rate (84.4% vs. 88.1%; p = .038). 75 When comparing TAVI to an open approach, a retrospective analysis carried out in 284 obese patients found that there was no difference in mortality at 30 days (5.2% vs.…”

Section: Tavi Versus Open Approachmentioning

confidence: 99%

Cardiac surgery in the morbidly obese

Djouani

Smith

Choi

et al. 2022

Journal of Cardiac Surgery

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Background: Obesity rates globally continue to rise and in turn the body mass index (BMI) of patients undergoing cardiac surgery is set to mirror this. Patients who are Class III obese (BMI ≥ 40) pose significant challenges to the surgical teams responsible for their care and are also at high risk of complications from surgery and even death. To improve outcomes in this population, interventions carried out in the preoperative, operative, and postoperative periods have shown promise. Despite this, there are no defined best practice national guidelines for perioperative management of obese patients undergoing cardiac surgery.Aim: This review is aimed at clinicians and researchers in the field of cardiac surgery and aims to form a basis for the future development of clinical guidelines for the management of obese cardiac surgery patients. Methods:The PubMed database was utilized to identify relevant literature and strategies employed at various stages of the surgical journey were analyzed.Conclusions: Data presented identified the benefits of preoperative respiratory muscle training, off-pump coronary artery bypass grafting where possible, and early extubation. Further randomized controlled trials are required to identify optimal operative and perioperative management strategies before the introduction of such guidance into clinical practice.

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Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement

Cited by 15 publications

References 41 publications

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

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

Cardiac surgery in the morbidly obese

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