Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Jun 2021)

Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement

  • Angela McInerney,
  • Gabriela Tirado‐Conte,
  • Josep Rodes‐Cabau,
  • Francisco Campelo‐Parada,
  • Jose D. Tafur Soto,
  • Marco Barbanti,
  • Erika Muñoz‐Garcia,
  • Mobeena Arif,
  • Diego Lopez,
  • Stefan Toggweiler,
  • Gabriela Veiga,
  • Anna Pylko,
  • Teresa Sevilla,
  • Miriam Compagnone,
  • Ander Regueiro,
  • Viçent Serra,
  • Manuel Carnero,
  • Juan F. Oteo,
  • Fernando Rivero,
  • Henrique Barbosa Ribeiro,
  • Leonardo Guimaraes,
  • Anthony Matta,
  • Natalia Giraldo Echavarria,
  • Roberto Valvo,
  • Federico Moccetti,
  • Antonio J. Muñoz‐Garcia,
  • Javier Lopez‐Pais,
  • Bruno Garcia del Blanco,
  • Diego Carter Campanha Borges,
  • Eric Dumont,
  • Nieves Gonzalo,
  • Enrico Criscione,
  • Maciej Dabrowski,
  • Fernando Alfonso,
  • Jose M de la Torre Hernández,
  • Asim N. Cheema,
  • Ignacio J. Amat‐Santos,
  • Francesco Saia,
  • Javier Escaned,
  • Luis Nombela‐Franco

DOI
https://doi.org/10.1161/JAHA.120.019051
Journal volume & issue
Vol. 10, no. 12

Abstract

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Background There is a paucity of outcome data on patients who are morbidly obese (MO) undergoing transcatheter aortic valve replacement. We aimed to determine their periprocedural and midterm outcomes and investigate the impact of obesity phenotype. Methods and Results Consecutive patients who are MO (body mass index, ≥40 kg/m2, or ≥35 kg/m2 with obesity‐related comorbidities; n=910) with severe aortic stenosis who underwent transcatheter aortic valve replacement in 18 tertiary hospitals were compared with a nonobese cohort (body mass index, 18.5–29.9 kg/m2, n=2264). Propensity‐score matching resulted in 770 pairs. Pre–transcatheter aortic valve replacement computed tomography scans were centrally analyzed to assess adipose tissue distribution; epicardial, abdominal visceral and subcutaneous fat. Major vascular complications were more common (6.6% versus 4.3%; P=0.043) and device success was less frequent (84.4% versus 88.1%; P=0.038) in the MO group. Freedom from all‐cause and cardiovascular mortality were similar at 2 years (79.4 versus 80.6%, P=0.731; and 88.7 versus 87.4%, P=0.699; MO and nonobese, respectively). Multivariable analysis identified baseline glomerular filtration rate and nontransfemoral access as independent predictors of 2‐year mortality in the MO group. An adverse MO phenotype with an abdominal visceral adipose tissue:subcutaneous adipose tissue ratio ≥1 (VAT:SAT) was associated with increased 2‐year all‐cause (hazard ratio [HR], 3.06; 95% CI, 1.20–7.77; P=0.019) and cardiovascular (hazard ratio, 4.11; 95% CI, 1.06–15.90; P=0.041) mortality, and readmissions (HR, 1.81; 95% CI, 1.07–3.07; P=0.027). After multivariable analysis, a (VAT:SAT) ratio ≥1 remained a strong predictor of 2‐year mortality (hazard ratio, 2.78; P=0.035). Conclusions Transcatheter aortic valve replacement in patients who are MO has similar short‐ and midterm outcomes to nonobese patients, despite higher major vascular complications and lower device success. An abdominal VAT:SAT ratio ≥1 identifies an obesity phenotype at higher risk of adverse clinical outcomes.

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