Key result
Obesity did not improve long-term survival after surgery for degenerative mitral valve disease (P=0.62), but increased the risk of acute kidney injury compared to normal weight (17% vs 5%; P=0.03).
Why the study?
Does body mass index affect early and long-term outcomes in patients undergoing mitral surgery for degenerative disease?
Cohort (n=715)
No
Does body mass index affect early and long-term outcomes in patients undergoing mitral surgery for degenerative disease?
An 'obesity paradox' does not exist after surgery for degenerative mitral valve disease, and obese patients face a higher risk of acute kidney injury and potentially worse late survival after repair.
Answers are grounded in this paper and cite their sources.
Obesity confers no survival benefit after degenerative mitral valve surgery; leaves open the obesity paradox while flagging AKI risk in observational data.
OBJECTIVES: This study was conducted to clarify the relationship between body mass index and mitral valve (MV) surgery and to determine whether an 'obesity paradox' exists in the context of surgery for degenerative MV disease. METHODS: In this retrospective single-centre study, we analysed data from 715 patients who underwent mitral surgery for degenerative disease from 2000 to 2015. Patients were classified according to body mass index: underweight (<20 kg/m2), normal weight (20-24.99 kg/m2), overweight (25-29.99 kg/m2) and obese (≥30 kg/m2). Early and long-term results were investigated. Multivariable analysis was conducted to identify risk factors for long-term mortality. RESULTS: Mean follow-up was 67 ± 44 months (range 0-190 months). There were no differences between groups regarding 30-day mortality (P = 0.35), stroke (P = 0.45), reoperation for bleeding (P = 0.9) and length of hospital stay (P = 0.31). Obese patients were at increased risk of acute kidney injury when compared with normal weight patients (17% vs 5%; P = 0.03) but not when compared with the other groups; this was confirmed within the subgroup with depressed ejection fraction (42% vs 10%, P = 0.02). No differences in long-term survival were found across groups for all patients (P = 0.62) and for patients with depressed ejection fraction (P = 0.6), with a trend towards worse survival in obese patients undergoing MV repair (P = 0.06). Survival in obese patients undergoing repair was significantly worse than that in obese patients undergoing replacement (P = 0.04). CONCLUSIONS: An 'obesity paradox' was not demonstrated after surgery for degenerative MV disease. Obese patients are more prone to acute kidney injury and have worse late survival after MV repair.
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Rapetto et al. (2017) conducted a cohort in Degenerative mitral valve disease (n=715). Body mass index (obesity) vs. Normal weight was evaluated on Long-term survival (p=0.62). Obesity did not improve long-term survival after surgery for degenerative mitral valve disease (P=0.62), but increased the risk of acute kidney injury compared to normal weight (17% vs 5%; P=0.03).
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