Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement
Key result
Morbidly obese patients undergoing TAVR had similar 2-year freedom from all-cause mortality compared to nonobese patients (79.4% vs 80.6%; P=0.731), but a VAT:SAT ratio ≥1 increased mortality risk.
Why the study?
Outcome data on morbidly obese patients undergoing transcatheter aortic valve replacement were limited, and the impact of obesity phenotype was unclear.
Does morbid obesity impact mortality and periprocedural outcomes in patients undergoing transcatheter aortic valve replacement for severe aortic stenosis?
Population
910 morbidly obese and 2,264 nonobese patients with severe aortic stenosis undergoing TAVR across 18 tertiary hospitals
Comparison
Morbidly obese vs nonobese patients
Design
Multicenter propensity-score matched cohort study
Follow-up
2 years
Authors
Discussion
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Member takes
Implication
Similar TAVR survival in morbid obesity warrants no practice change; leaves open VAT:SAT ratio's role in risk stratification.
Study Design
Type
Cohort (n=3,174)
Multicenter
Yes
Structured PICO
Does morbid obesity impact mortality and periprocedural outcomes in patients undergoing transcatheter aortic valve replacement for severe aortic stenosis?
P
Population
3,174 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (910 morbidly obese, 2,264 nonobese; 770 propensity-matched pairs), followed for 2 years.
E
Exposure
Transcatheter aortic valve replacement in morbidly obese patients
C
Comparator
Transcatheter aortic valve replacement in nonobese patients
O
Outcome
All-cause and cardiovascular mortality at 2 yearshard clinical
Main Result
Absolute Event Rate: 79.4% vs 80.6%
p-value: p=0.731
Morbidly obese patients undergoing TAVR have similar 2-year mortality compared to nonobese patients, though an adverse obesity phenotype (VAT:SAT ratio ≥1) identifies a subgroup at higher risk for mortality and readmissions.
Cite This Study
McInerney et al. (2021) conducted a cohort in Severe aortic stenosis (n=3,174). Morbid obesity vs. Nonobese (BMI 18.5-29.9 kg/m2) was evaluated on Freedom from all-cause mortality at 2 years (p=0.731). Morbidly obese patients undergoing TAVR had similar 2-year freedom from all-cause mortality compared to nonobese patients (79.4% vs 80.6%; P=0.731), but a VAT:SAT ratio ≥1 increased mortality risk.