Obesity, Fat Tissue Distribution, and Muscle Loss Affect TAVR Short- and Long-Term Morbidity and Mortality

Objectives: Patients who undergo TAVR are at the highest risk due to chronic morbidity. Despite cardiovascular pathogenicity, the effect of long-term outcome improvement in chronic diseases is described for obesity. In addition, everyone also shows an over-mortality under Saropenia, so that an obesity paradox is described. Here we examined the relevance of various fat and lean tissue areas for the result according to TAVR.

Methods: A total of 403 TAVR patients were quantified for subcutaneous, visceral and epicardial fat and muscle area (preoperative CT). We correlated these parameters and their quotients for perioperative morbidity and short and long-term mortality. We analyzed the predictive value of the quantification of muscle and fat tissue with regard to the outcome univariate and multivariate.

Result: A total of 403 patients (51% female, 97 transapical (TA), 306 transfemoral (TF)) aged 79.8 ± 1.4 years (TA) and 81.3 ± 0.4 years (TF) (p = 0.174) showed overall survival (30 days)/1 year) of 97/86% (TA) and 98/87% (TF). Sarcopenia and obesity as well as combinations of both parameters led to increased morbidity and mortality. Muscle and fat tissue were independent of each other. Overweight patients showed higher morbidity despite younger age. Obesity was associated with prolonged hospital and intensive care stays, inflammation and lactate concentration, and respiratory support. Obese Patients frequently showed vascular bleeding and increased rates of permanent pacing. An increased BMI correlated with an increased 30-day mortality and a reduced 1-year survival. While all fat deposits correlated positively with the BMI, only increased epicardial fat and visceral abdominal fat showed significant mortality correlation. Variations in the amount of subcutaneous fat had only minor, insignificant effects. Short and long-term mortality was increased in people with high epicardial and visceral fat deposits and lumbar muscle reduction. Sarcopenia was a strong independent predictor of long-term mortality. In particular, increased visceral fat/muscle ratios and a reduction in muscle volume alone increased 30-day and 1-year mortality.

Conclusion: Morbidly increased visceral fat and epicardium levels contribute to increased inflammation, deterioration in metabolism, perioperative adverse events and escalated mortality. Sarcopenia, on the other hand, is also an independent enhancer of the adverse result. The adverse effects of morbid obesity and sarcopenia instead of a paradox for obesity affect postoperative morbidity and mortality in TAVR patients

Publication History

Article published online:
19 February 2021