TAVR vs. surgery among obese patients: What cardiologists need to know
Transcatheter aortic valve replacement (TAVR) is safe and effective for obese patients presenting with severe aortic stenosis (AS), according to a new meta-analysis published in the American Journal of Cardiology.[1]
“Obesity, defined as a body mass index (BMI) ≥30 kg/m2, is very prevalent in patients who are being referred for treatment of severe AS, and recent data has estimated that 13% to 17% of patients referred to TAVR are obese,” wrote first author Khalid Saeed Al-Asad, MD, with the department of internal medicine at Michigan State University, and colleagues. “Evidence supporting the safety of TAVR in obese patients, however, is limited and the best therapeutic approach in this patient population remains debatable.”
Al-Asad et al. reviewed data from nearly 38,000 patients who underwent TAVR or surgical aortic valve replacement (SAVR) for severe AS. All patients presented with a BMI of at least 30 kg/m2 and were originally included in one of four studies completed from 2017 to 2022.
While 22.2% of patients included in the analysis underwent TAVR, the other 77.8% underwent surgical aortic valve replacement. TAVR patients had a higher mean age (77 years old) than SAVR patients (67 years old) and were more likely to be female (58% vs. 44%).
In-hospital mortality, acute kidney injury, postoperative sepsis and blood transfusion rates were all lower among TAVR patients than SAVR patients. However, the authors noted, permanent pacemakers were more needed more frequently after TAVR than SAVR.
The researchers also noted that transfemoral TAVR may not be a suitable approach for some obese patients with severe AS.
“The transfemoral approach, which has been traditionally utilized for TAVR, could theoretically present a challenge in this patient population and might warrant the use of alternative access including transradial, transcaval, transapical, or transcarotid,” the group wrote.
Al-Asad et al. ultimately concluded that, despite these positive findings, additional research is still needed, especially on the long-term impact of treating obese patients with TAVR vs. SAVR.
Read the full study here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.