The obesity paradox in patients undergoing transcatheter aortic valve implantation: is there any effect of body mass index on survival?

Tokarek, Tomasz; Dziewierz, Artur; Sorysz, Danuta; Bagieński, Maciej; Rzeszutko, Łukasz; Krawczyk‐Ożóg, Agata; Dudek, Dariusz; Kleczyński, Paweł

doi:10.5603/kp.a2018.0243

Cited by 17 publications

(17 citation statements)

References 28 publications

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“…Calculation of BMI has been widely used in risk stratification with conflicting results. We have also found that BMI was not associated with mortality (17,52). The serum albumin is a good indicator of malnutrition.…”

Section: Discussionmentioning

confidence: 53%

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

Tóth¹,

Szabó²,

Nagy³

et al. 2021

Ann Palliat Med

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Background: The frailty score has been developed to determine physiological functioning capacity. The aim of our research was to explore the relationship between frailty factors and mortality in cardiac surgery patients.Methods: Our research is an observational, single-center, prospective cohort study (registered on ClinicalTrials.gov: NCT02224222), and we studied 69 patients who underwent elective cardiac surgery between 2014 and 2017. Thirty days before the surgery, they completed a questionnaire that contained questions related to social support, self-reported life quality-happiness, cognitive functions, anxiety and depression. Demographic, anthropometric and medical data were widely collected. The Geriatric Nutritional Risk Index (GNRI) and the Comprehensive Geriatric Assessment (CGA)-based frailty index were calculated as a sum and the domains, respectively. Cox regression and the Kaplan-Meier tests were applied to analyze survival and relative risk. The primary outcome was mid-term mortality.Results: The patients' mean age was 65.43 years [standard deviation (SD): 9.81 years]. The median followup was 1,656 days of survival [interquartile range (IQR), 1,336-2,081 years], during this period 14 patients died. The median of EuroSCORE II was 1.56 (1.00-2.58) points. The median preoperative albumin level was 32.80 g/L (IQR, 29.9-35.8 g/L). Major adverse cardiovascular and cerebral events (MACCEs) occurred 7 times during follow-up. The nutrition score of the CGA was significantly associated with worse long-term survival [score; hazard ratio (HR): 5.35; 95% CI: 1.10-25.91, P=0.037]. After adjustment for EuroSCORE II and postoperative complications the noncardiovascular CGA score was associated with overall mortality [adjusted hazard ratio (AHR): 1.44, 95% CI: 1.02-2.04, P=0.036]. In the multivariable Cox regression, GNRI <91 showed an increased risk for mortality (AHR: 4.76, 95% CI: 1.52-14.92, P=0.007). Conclusions:The CGA-based noncardiovascular score and nutritional status should be assessed before cardiac surgery prehabilitation and may help decrease long-term mortality.

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Section: Discussionmentioning

confidence: 53%

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

Tóth¹,

Szabó²,

Nagy³

et al. 2021

Ann Palliat Med

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“…1,11,15,16,21,25,27,29,32,40,41,[43][44][45][46][47][48][49][51][52][53][54][55] Similar to previous studies, it was patients with low BMI that tended to have inferior outcomes. 1,21,29,41,44,45,47,50,51,[53][54][55] Second, postoperative complications such as MI, stroke, reoperation rates, AKI, new renal failure, requirement of dialysis, were postoperative bleeding are either superior in patients with higher BMI or equivalent to their normal BMI counterparts. 1,11,15,16,21,25,27,29,32,[40][41][42][43][44]…”

Section: Postoperative Complicationsmentioning

confidence: 86%

“…Patients with underweight were found to have high risk of AKI with 54 Vaduganathan et al found rates of postoperative MI and stroke did not differ between groups, but rates of reoperation were significantly different between groups. 2%, 2%, 1% and 3% (p = .04) of patients with underweight, normal weight, overweight and obesity required reoperation.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Heart valve surgery and the obesity paradox: A systematic review

et al. 2021

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Obesity has been associated with increased incidence of comorbidities and shorter life expectancy, and it has generally been assumed that patients with obesity should have inferior outcomes after surgery. Previous literature has often demonstrated equivalent or even improved rates of mortality after cardiac surgery when compared to their lower-weight counterparts, coined the obesity paradox. Herein, we aim to review the literature investigating the impact of obesity on surgical valve interventions. PubMed and Embase were systematically searched for articles published from

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“…Tokarek et al showed that increased BMI was independently associated with 1-year survival benefit after TAVR. However, there was no difference between the groups in terms of 30-day allcause mortality [5].…”

Section: Introductionmentioning

confidence: 73%

Contemporary Results of Transcatheter Aortic Valve Replacement in Obese Patients

Owais

Garhy

Lauten

et al. 2020

Cardiology Research and Practice

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Background. Little research has been conducted to explore the postoperative outcomes of obese patients after transfemoral transcatheter aortic valve replacement (TF-TAVR). Objective. We investigated the influence of body mass index (BMI) on 1-year outcomes after TF-TAVR. Methods. We included retrospectively 1609 high- and intermediate-risk TAVR patients (mean EuroSCORE II 21 ± 11) operated under general anesthesia between March 2014 and March 2018 in central hospital, Bad Berka, Germany. We stratified the patients according to BMI. Results. Our demographic data analysis showed 41% of patients were male and the mean age was 78 (range, 61–92 years). According to the WHO classification, 33% patients had normal weight, 42% were defined as overweight, and 22% were obese. Obese patients showed statistically significant difference in their clinical parameters as having higher incidence of hypertension, diabetes mellitus, pulmonary hypertension, and chronic obstructive pulmonary disease; on the contrary, obese patients were found to be younger than others. We found no differences in valve types and sizes among the different BMI categories. Our mortality rate during the 1-year follow-up period was 17.8% (287 patients). Mortality was significantly higher in patients with BMI < 25 kg/m2 (1 year mortality 149 patients 28.2% in patients with BMI < 25 kg/m2 vs. 138 patients 12.6% in patients with BMI ≥ 25 kg/m2; P=0.0001). Even after considering the confounding risk factors, BMI ≥ 25 kg/m2 was independently associated with reduced 1 year mortality (odds ratio (OR): 0.36, 95% confidence interval (CI): 0.21–0.6; P=0.01) in multivariate logistic regression analysis. The rate of vascular complication was higher in patients with BMI ≥ 25 kg/m2. However, the rate of blood transfusion was higher in patients with BMI < 25 kg/m2. All other serious complications occurred with equal distribution in both groups. Conclusion. In our single-center study, BMI ≥ 25 kg/m2 was independently associated with lower 1 year mortality after TF-TAVR.

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The obesity paradox in patients undergoing transcatheter aortic valve implantation: is there any effect of body mass index on survival?

Cited by 17 publications

References 28 publications

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

Heart valve surgery and the obesity paradox: A systematic review

Contemporary Results of Transcatheter Aortic Valve Replacement in Obese Patients

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