In-Hospital Outcomes of Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Obese Patients: A Meta-Analysis

Al-Asad, Khalid Saeed; Martínez, A.; Yavari, Majid; Panama, Gabriel; Abela, George S.

doi:10.1016/s0735-1097(23)01514-0

Cited by 2 publications

(3 citation statements)

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“…A meta-analysis of 8353 obese patients undergoing SAVR revealed a combined premature death rate of 2%. 12 Generally, this rate is observed in the literature at a range of 1–3%. 8,9,12,13 Nevertheless, a multicenter Italian national cohort study reported a slightly higher 30-day mortality rate of 4.2% for SAVR in the group of patients with obesity.…”

Section: Discussionmentioning

confidence: 92%

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Optimizing aortic valve prosthesis selection in patients with obesity: Institutional experience with multidisciplinary perspective

Balkanay,

Bulut,

Albrahimi

et al. 2023

Asian Cardiovasc Thorac Ann

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Background Aortic valve diseases are life-threatening conditions with increasing prevalence worldwide. Risk factors include gender, age, hypertension, dyslipidemia, and type 2 diabetes. Obesity is closely related to these risk factors and has been linked to a higher risk of developing aortic valve diseases. However, there is no specific guideline for managing aortic valve disease in patients with obesity, and the choice of valve type remains uncertain. Methods A total of 130 patients with obesity who met the inclusion criteria underwent surgical aortic valve replacement. The patients were divided into two groups based on the type of prosthesis used. Among the study cohort, 50 patients received a bioprosthetic valve, while 80 patients received a mechanical valve. We compared these groups in terms of perioperative characteristics and follow-up results. Statistical significance was determined using a p-value threshold of 0.05. Results There were no significant differences in age, gender, body mass index, or cardiac comorbidities between the two groups. Preoperative blood results and echo findings also showed no significant differences. Intraoperative characteristics and postoperative outcomes, including mortality and acute kidney injury, did not differ significantly between the groups. In addition, BHVG patients had shorter ICU stays compared to MHVG patients without significance. Conclusion Deliberate consideration is crucial when selecting valves for obese patients, particularly those with class II obesity. This is due to the potential influence of obesity on valve types, as well as the need to account for the possibility of bariatric surgery and its potential effects.

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Section: Discussionmentioning

confidence: 92%

“…12 Generally, this rate is observed in the literature at a range of 1–3%. 8,9,12,13 Nevertheless, a multicenter Italian national cohort study reported a slightly higher 30-day mortality rate of 4.2% for SAVR in the group of patients with obesity. However, the 5-year survival rate for this group, with a mean age of 79, was 71%.…”

Section: Discussionmentioning

confidence: 92%

Optimizing aortic valve prosthesis selection in patients with obesity: Institutional experience with multidisciplinary perspective

Balkanay,

Bulut,

Albrahimi

et al. 2023

Asian Cardiovasc Thorac Ann

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“…A previous meta-analysis by Du et al [67] showed similar results for what concerns the 30-day clinical endpoint between BAV subtypes such as mortality, stroke, and lifethreatening bleeding, even if fewer studies were considered in the overall analysis. Thirtyday stroke was found to be significantly higher in BAV patients undergoing TAVR with respect to patients with TAV [68]: the larger extent of calcifications and the need for preand post-dilation in BAV anatomies are advocated as being responsible for this finding. In a recent study by Zhang et al [69] in BAV patients, the use of cerebral embolic protection devices (CEPDs) led to a significantly lower incidence of procedural stroke, whereas in TAV patients the evidence about the utility of CEPDs is conflicting: BAV anatomy might be a subgroup of TAVR patients that could benefit from the use of such devices in cases of severe calcification (usually more represented when a raphe is present) or need for valve preparation and post-dilation.…”

Section: Discussionmentioning

confidence: 93%

A Meta-Analysis of Short-Term Outcomes of TAVR versus SAVR in Bicuspid Aortic Valve Stenosis and TAVR Results in Different Bicuspid Valve Anatomies

Improta,

Di Pietro,

Kola

et al. 2023

JCM

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Background: To provide a comprehensive analysis of the current literature comparing the outcomes of surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (BAS), with particular attention to BAV morphology in patients undergoing TAVR. Methods: Following PRISMA guidelines, all relevant articles with no design restrictions from PubMed, CCTR (Cochrane Controlled Trials Register), and Google Scholar were screened for inclusion. Studies were included if they reported clinical endpoints for SAVR and TAVR or, in BAS treated with TAVR, for type 1 and non-type 1 morphology. Odds ratio and Cohen’s D were considered as effect size measurements for qualitative and quantitative variables, respectively. Results: A total of eight studies comparing short-term outcomes between SAVR and TAVR and nine studies with outcomes data between type 1 and non-type 1 BAS treated with TAVR were considered for the final analysis. No statistically significant difference was found for what concerns the rates of death, stroke, and acute kidney injury between SAVR and TAVR. In comparison to patients undergoing SAVR, the incidence of PPI (permanent pacemaker implantation) was greater in the TAVR group (OR 0.35, 95% CI 0.15–0.79, p = 0.01), and the frequency of bleeding events was found to be higher among patients undergoing SAVR (OR 4.3, 95% CI 2.9–6.4, p < 0.001). The probabilities of 30-day mortality, stroke, and any bleeding were not significantly affected by bicuspid valve morphology in TAVR patients. PPI or development of new conduction anomalies was found to be more frequent in type 1 anatomies (OR 0.46, 95% CI 0.30–0.70, p <0.001). Mildly lower post-procedural transprothesic gradients were found in patients with type 1 morphology. Conclusions: In BAS patients, TAVR has comparable short-term outcomes rates with SAVR, but higher PPI rates and lower incidence of bleeding events. In patients undergoing TAVR, type 1 BAS is associated with lower postoperative transvalvular gradients but higher PPI rates and conduction abnormalities

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In-Hospital Outcomes of Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Obese Patients: A Meta-Analysis

Cited by 2 publications

References 0 publications

Optimizing aortic valve prosthesis selection in patients with obesity: Institutional experience with multidisciplinary perspective

Optimizing aortic valve prosthesis selection in patients with obesity: Institutional experience with multidisciplinary perspective

A Meta-Analysis of Short-Term Outcomes of TAVR versus SAVR in Bicuspid Aortic Valve Stenosis and TAVR Results in Different Bicuspid Valve Anatomies

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