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Domondon IAA, Jeyakumar D, Raake M, Halaharvi SP, Zafar F, Contreras Vazquez SA, Abarca YA, Goli SR, Rohra D, Shah F, Sikander M, Al-Tawil M. Outcomes of Surgical Versus Transcatheter Aortic Valve Replacement in Obese Patients: A Systematic Review and Meta-Analysis. Cardiol Rev 2024:00045415-990000000-00321. [PMID: 39254505 DOI: 10.1097/crd.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) has been increasingly preferred over surgical aortic valve replacement (SAVR) for treating patients with severe aortic stenosis and intermediate to high surgical risk. Recent studies have indicated that obesity may confer protective benefits in cardiac surgery, known as the obesity paradox. We conducted a systematic review and meta-analysis to explore how obesity influences outcomes of TAVI versus SAVR. We searched and reviewed relevant studies comparing TAVI and SAVR in obese patients with aortic stenosis indexed in PubMed, Embase, and Scopus databases. Data from 5 studies with 16,161 patients (TAVI, n = 2951; SAVR, n = 13,210) were included. There was a lower incidence of postprocedural in-hospital mortality [risk ratio (RR), 0.64; 95% confidence interval (CI), 0.41-0.98; P = 0.04], acute kidney injury (RR, 0.53; 95% CI, 0.38-0.73; P = 0.0001), and shorter duration of in-hospital stay (mean difference: -3.35; 95% CI, -4.93 to -1.76; P = 0.0001) in TAVI versus SAVR. There was no significant difference in the risk of postoperative stroke (RR, 0.93; 95% CI, 0.29-3.02; P = 0.91), major bleeding (RR, 0.71; 95% CI, 0.47-1.07; P = 0.10), and myocardial infarction (RR, 0.64; 95% CI, 0.39-1.06; P = 0.08) between TAVI and SAVR. Higher incidences of PPM implantation (RR, 2.0; 95% CI, 1.38-2.90; P = 0.0003) and major vascular complications (RR, 1.51; 95% CI, 1.01-2.27; P = 0.05) were observed with TAVI. In obese patients, TAVI offers similar results as in the general population when compared with SAVR, except for increased vascular complications. An individualized approach can lead to optimal outcomes in this subpopulation.
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Affiliation(s)
- Ileana Anika A Domondon
- From the Emergency Medicine Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Deepapriya Jeyakumar
- Internal Medicine Department, Government Sivagangai Medical College, Tamil Nadu Dr. M.G.R Medical University, Sivagangai, India
| | - Mohammed Raake
- Faculty of Medicine, Annamalai University, Chidambaram, Cuddalore, India
| | - Savitri Poornima Halaharvi
- Department of Cardiology, JSS Medical College, Rajiv Gandhi University of Health Sciences, Mysore, India
| | - Fabeha Zafar
- Department of Cardiology, Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Yozahandy A Abarca
- Department of Cardiology, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Snehitha Reddy Goli
- Department of Cardiology, College of Medicine, Zhengzhou University, Henan Province, Henan, China
| | - Divya Rohra
- Department of Cardiology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Farah Shah
- Internal Medicine Department, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Mohammed Sikander
- Department of Cardiology, School of Medicine, University of Texas Rio Grande Valley, TX; and
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Seo J, Kharawala A, Borkowski P, Singh N, Akunor H, Nagraj S, Avgerinos DV, Kokkinidis DG. Obesity and Transcatheter Aortic Valve Replacement. J Cardiovasc Dev Dis 2024; 11:169. [PMID: 38921670 PMCID: PMC11203863 DOI: 10.3390/jcdd11060169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
Amidst an aging population and escalating obesity prevalence, elucidating the impact of obesity on transcatheter aortic valve replacement (TAVR) outcomes becomes paramount. The so-called "obesity paradox"-a term denoting the counterintuitive association of obesity, typically a risk factor for cardiovascular diseases, with improved survival outcomes in TAVR patients relative to their leaner or normal-weight counterparts-merits rigorous examination. This review comprehensively investigates the complex relationship between obesity and the clinical outcomes associated with TAVR, with a specific focus on mortality and periprocedural complications. This study aims to deepen our understanding of obesity's role in TAVR and the underlying mechanisms of the obesity paradox, thereby optimizing management strategies for this patient demographic, tailored to their unique physiological and metabolic profiles.
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Affiliation(s)
- Jiyoung Seo
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.)
| | - Amrin Kharawala
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.)
| | - Pawel Borkowski
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.)
| | - Nikita Singh
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.)
| | - Harriet Akunor
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.)
| | - Sanjana Nagraj
- Department of Cardiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | | | - Damianos G. Kokkinidis
- Section of Cardiovascular Medicine, Lawrence Memorial Hospital & Northeast Medical Group, Yale New Haven Heath, New London, CT 06614, USA
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Saeed Al-Asad K, Martinez Salazar A, Yavari M, Panama G, Sabanci R, Saeed M, Abela G. In-Hospital Outcomes of Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Obesity. Am J Cardiol 2023; 201:391-393. [PMID: 37438228 DOI: 10.1016/j.amjcard.2023.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/14/2023] [Accepted: 06/24/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Khalid Saeed Al-Asad
- Departments of Internal Medicine, Michigan State University, East Lansing, Michigan.
| | | | - Majid Yavari
- Departments of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Gabriel Panama
- Departments of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Rand Sabanci
- Departments of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Moiz Saeed
- Departments of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - George Abela
- Departments of Cardiology, Michigan State University, East Lansing, Michigan
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McInerney A, García Márquez M, Tirado-Conte G, Bernal JL, Fernández-Pérez C, Jiménez-Quevedo P, Gonzalo N, Núñez-Gil I, Del Prado N, Escaned J, Fernández-Ortiz A, Elola J, Nombela-Franco L. In-hospital outcomes following percutaneous versus surgical intervention in the treatment of aortic stenosis and concomitant coronary artery disease. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023:S1885-5857(23)00025-7. [PMID: 36669732 DOI: 10.1016/j.rec.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION AND OBJECTIVES Concomitant coronary artery disease (CAD) is prevalent among aortic stenosis patients; however the optimal therapeutic strategy remains debated. We investigated periprocedural outcomes among patients undergoing transcatheter aortic valve implantation with percutaneous coronary intervention (TAVI/PCI) vs surgical aortic valve replacement with coronary artery bypass grafting (SAVR/CABG) for aortic stenosis with CAD. METHODS Using discharge data from the Spanish National Health System, we identified 6194 patients (5217 SAVR/CABG and 977 TAVI/PCI) between 2016 and 2019. Propensity score matching was adjusted for baseline characteristics. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were in-hospital complications and 30-day cardiovascular readmission. RESULTS Matching resulted in 774 pairs. In-hospital all-cause mortality was more common in the SAVR/CABG group (3.4% vs 9.4%, P <.001) as was periprocedural stroke (0.9% vs 2.2%; P=.004), acute kidney injury (4.3% vs 16.0%, P <.001), blood transfusion (9.6% vs 21.1%, P <.001), and hospital-acquired pneumonia (0.1% vs 1.7%, P=.001). Permanent pacemaker implantation was higher for matched TAVI/PCI (12.0% vs 5.7%, P <.001). Lower volume centers (< 130 procedures/y) had higher in-hospital all-cause mortality for both procedures: TAVI/PCI (3.6% vs 2.9%, P <.001) and SAVR/CABG (8.3 vs 6.8%, P <.001). Thirty-day cardiovascular readmission did not differ between groups. CONCLUSIONS In this large contemporary nationwide study, percutaneous management of aortic stenosis and CAD with TAVI/PCI had lower in-hospital mortality and morbidity than surgical intervention. Higher volume centers had less in-hospital mortality in both groups. Dedicated national high-volume heart centers warrant further investigation.
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Affiliation(s)
- Angela McInerney
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Gabriela Tirado-Conte
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigaciones Sanitarias de Santiago (idis), Santiago de Compostela, A Coruña, Spain
| | - Pilar Jiménez-Quevedo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Nieves Gonzalo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Iván Núñez-Gil
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Javier Escaned
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Antonio Fernández-Ortiz
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
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Biancari F. Transcatheter or surgical aortic valve replacement in severely obese patients? EUROINTERVENTION 2022; 18:e360-e361. [PMID: 35929070 PMCID: PMC10241287 DOI: 10.4244/eij-e-22-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy.,Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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