Transcatheter aortic valve replacement (TAVR) is much riskier when treating patients with severe obesity than it is in patients with a normal BMI, according to new findings published in Current Problems in Cardiology.[1]
“Despite the growing number of TAVR procedures performed annually, data on inpatient outcomes specifically related to obesity and its various classifications are scarce,” wrote first author Omar Al Wahadneh, MBBS, a researcher with Carle Foundation Hospital in Urbana, Illinois, and colleagues. “This gap in knowledge hinders optimal patient selection and pre-procedural risk stratification, potentially impacting the success and safety of TAVR in this increasingly prevalent population. Addressing this gap is crucial to optimize TAVR care for patients with obesity and maximize their chances of a successful and lasting recovery.”
The Centers for Disease Control and Prevention (CDC) defines obesity as any individual with a body mass index (BMI) of 30 or higher. Class 1 obesity is a BMI of 30 to <35, class II obesity is a BMI of 35 to <40 and class III obesity, also known as severe obesity, is a BMI of 40 or higher.
Wahadneh et al. explored more than 217,000 TAVR hospitalizations from 2016 to 2020. All data came from the National Inpatient Sample. While 84.4% of patients presented with a normal BMI, 5.3% had class I obesity, 4.5% had class II obesity and 5.6% had class III obesity/severe obesity. Patients with class III obesity had a lower median age (71.7 years old) than any other patient group and were the most likely group to present with congestive heart failure, diabetes, liver disease, chronic obstructive pulmonary disease or pulmonary circulation disorders.
There were no significant differences in in-hospital mortality between these groups. However, compared to patients with a normal BMI, patients with class III obesity were associated with a longer median length of stay (3.6 days vs. 3.1 days), higher overall healthcare costs ($71,000 vs. $73,000) and higher odds of developing post-TAVR heat failure, complete heart block, pneumonia, vascular complications. Acute kidney injuries and permanent pacemaker implantation, two common TAVR complications heart teams are constantly working to keep to a minimum, was also more likely among severely obese patients.
“Importantly, no distinctions were noted in paravalvular leakage, cardiogenic shock, or postoperative stroke across all groups compared to the normal BMI category,” the authors added. “Further research is essential to comprehensively understand the long-term impact of obesity on specific complications and recovery post-TAVR.”
The full analysis is available here.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.