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Title: Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement.
Authors: McInerney, Angela
Tirado-Conte, Gabriela
Rodes-Cabau, Josep
Campelo-Parada, Francisco
Tafur Soto, Jose D
Barbanti, Marco
Muñoz-Garcia, Erika
Arif, Mobeena
Lopez, Diego
Toggweiler, Stefan
Veiga, Gabriela
Pylko, Anna
Sevilla, Teresa
Compagnone, Miriam
Regueiro, Ander
Serra, Viçent
Carnero, Manuel
Oteo, Juan F
Rivero, Fernando
Barbosa Ribeiro, Henrique
Guimaraes, Leonardo
Matta, Anthony
Giraldo Echavarria, Natalia
Valvo, Roberto
Moccetti, Federico
Muñoz-Garcia, Antonio J
Lopez-Pais, Javier
Garcia Del Blanco, Bruno
Campanha Borges, Diego Carter
Dumont, Eric
Gonzalo, Nieves
Criscione, Enrico
Dabrowski, Maciej
Alfonso, Fernando
de la Torre Hernández, Jose M
Cheema, Asim N
Amat-Santos, Ignacio J
Saia, Francesco
Escaned, Javier
Nombela-Franco, Luis
Keywords: epicardial adipose tissue;morbid obesity;subcutaneous adipose tissue;transcatheter aortic valve replacement;visceral adipose tissue
metadata.dc.subject.mesh: Adiposity
Aged, 80 and over
Aortic Valve Stenosis
Body Mass Index
Intra-Abdominal Fat
Obesity, Morbid
Postoperative Complications
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Subcutaneous Fat
Time Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
United States
Issue Date: 31-May-2021
Abstract: 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.
metadata.dc.identifier.doi: 10.1161/JAHA.120.019051
Appears in Collections:Producción 2020

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