Transcatheter Aortic Valve Implantation in Patients with Super Obesity: Defining a High-Risk Phenotype

Background: The long-term impact of super obesity (body mass index BMI ≥50 kg/m²) on outcomes after transcatheter aortic valve implantation (TAVI) is not well defined. Methods: We used the 2015–2020 Nationwide Readmissions Database to identify TAVI procedures and compared patients with super obesity to those with BMI <50 kg/m². Propensity score–matched cohorts were constructed using clinical covariates. We evaluated net adverse cardiovascular events (NACE; composite of in-hospital mortality, stroke, and major bleeding), mortality, and complications during index admission and at 30 and 180 days. A prespecified subgroup analysis compared super-obese with normal-BMI patients. Results: Among 184,199 TAVI procedures, 4,669 patients (2,369 super obese, 2,300 non–super obese) were included in the matched cohort. Super-obese TAVI volume increased over time. At index admission, super-obesity was associated with higher odds of NACE (adjusted odds ratio aOR 1.57, 95% CI 1.12–2.20), in-hospital mortality (aOR 8.08, 95% CI 3.19–20.48), and acute kidney injury (aOR 1.48, 95% CI 1.25–1.74), whereas stroke and major bleeding did not differ. At 30 days, only acute kidney injury remained higher in super-obese patients, and by 180 days only permanent pacemaker implantation was increased (aOR 2.55, 95% CI 1.34–4.85).In subgroup analyses restricted to super-obese versus normal-BMI patients, super-obesity was associated with higher NACE and complications at index admission and 180 days. Conclusions: Super-obese TAVI recipients have higher early risk and persistent excess risk for selected complications, indicating that extreme obesity defines a higher-risk TAVI phenotype despite broadly comparable longer-term outcomes versus patients with lower BMI.