Impact of BMI on Postoperative Outcome after TAVI

Objectives: Obesity is an independent risk factor for cardiovascular disease and has a paradox effect on postoperative outcome after cardiac surgery. For patients who underwent transcatheter aortic valve implantation (TAVI), the prognostic roles of obesity and high body mass index remain controversial. Therefore, the aim of our retrospective study was to evaluate whether the obesity paradox exists in patients undergoing TAVI.

Methods: A total of 1,215 patients undergoing TAVI (1,113 patients transfemoral and 102 patients transapical) from 2010 to 2020 at a single institution were categorized by body mass index (BMI): <20 kg/m² (Group 1), 20–25 kg/m² (Group 2), 25–35 kg/m² (Group 3), and ≥35 kg/m² (Group 4), respectively. Baseline patient characteristics, procedural (fluoroscopy time and dose area product) and clinical outcomes including 30-day mortality, pacemaker rate, postoperative arrhythmia, vascular complications were compared between the BMI categories.

Result: Extreme obesity was diagnosed in (9%) patients, (61%) patients were overweight, (3.5%) underweight and (26.5%) had normal weight. There was no difference between the groups in terms of 30-day all-cause mortality (Group 1: 7.14%, Group 2: 7.76%, Group 3: 5.4%, Group 4: 2.72%), postoperative wound complications and vascular complications. Increase in BMI was associated with higher procedural dose area. Decrease in BMI was associated with lower procedural dose area shorter fluoroscopy time, higher pacemaker rate and postoperative arrhythmia.

Conclusion: Despite the well-documented adverse effects of increased body weight on health, overweight and obesity are not associated with higher vascular complications or higher mortality rate following TAVI when compared with normal weight. However, a decreased BMI has a negative impact on postoperative arrhythmia and pacemaker rates. The consequence of a higher dose rate in the overweight groups should be controlled in future studies.

Publication History

Article published online:
19 February 2021