Courtesy of Dr. Carlos Fava.
Body mass index (BMI) has always played an important role in heart surgery. However, there is little evidence on BMI effects on TAVI.
This study included 491 patients, which were divided according to BMI into:
- low (<20 Kg/m2 )
- normal (20-24.9 Kg/m2 )
- overweight (25-30 Kg/m2 )
- obese (>30 Kg/m2 )
BMI was low in 43 patients (8.7%), normal in 148 (30.1%), overweight in 162 (33%) and obese in 138 (28.1%).
Obese patients were younger, diabetes was more frequent among morbid obese, but there were fewer with prior MI.
STS score was inversely associated with BMI:
Low weight: 11.4±4.9
Normal: 9.1±4.8
Overweight: 8.4±4.3
Obesity: 7.9±4
[p<0.001]
Ejection fraction was also inversely associated to BMI, but the opposite happened with the aortic valve area.
There was no difference in procedural success, except for longer fluoroscopy time in the group with morbid obesity. Vascular complications and transfusions (VARC-2 criteria) were higher in the low BMI group, while acute kidney injury was higher in the highest BMI group.
At one year follow up, all-cause mortality was higher in the low BMI group compared to the other 3 groups (p=0.003).
In multivariable analyzis, BMI <20 Kg/m2 was an independent predictor of mortality (HR=2.45; p=0.01).
Conclusion
Body mass index <20 Kg/m2 should be considered a fragility marker during screening for TAVI of patients with severe aortic stenosis, since it is associated to high mortality, while obese patients presented similar mortality risk to those of normal weight.
Editorial Comment
BMI should be included as part of patient screening routine procedures when considering TAVI, because it is associated with in-hospital complications and mortality. BMI could be used as a sign of fragility. We should controlling fluid balance in morbid obesity because these patients present higher kidney failure rate after implantation, which can be associated to loss of volume, hard to recover immediately after procedure.
Courtesy of Dr. Carlos Fava. Favaloro Foundation, Buenos Aires, Argentina.
Original Title: Body Mass Index Association with Survival in Severe Aortic Stenosis Patients Undergoing Transcatheter Aortic Valve Replacement
Reference: Edward Koifman, et al. Cateheterization cardiovascular Intervention 2016;88:118-124
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