Abstract
BackgroundMost of the studies of obesity and postoperative outcome have looked predominantly at coronary artery bypass grafting with fewer focused on valvular disease. The purpose of this study was to compare the outcomes of patients undergoing aortic valve replacement stratified by body mass index (BMI, kg/m^2).MethodsThe Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry captured 4780 aortic valve replacements in Alberta, Canada from January 2004 to December 2018. All recipients were stratified by BMI into five groups (BMI: < 20, 20–24.9, 25–29.9, 30–34.9, and > = 35). Log-rank test and Cox regression were used to examine the crude and adjusted survival differences.ResultsIntra-operative clamp time and pump time were similar among the five groups. Significant statistical differences between groups existed for the incidence of isolated AVR, AVR and CABG, hemorrhage, septic infection, and deep sternal infection (p < 0.05). While there was no significant statistical difference in the mortality rate across the BMI groups, the underweight AVR patients (BMI < 20) were associated with increased hazard ratio (1.519; 95% confidence interval: 1.028–2.245) with regards to all-cause mortality at the longest follow-up compared with normal weight patients.ConclusionOverweight and obese patients should be considered as readily for AVR as normal BMI patients.
Highlights
Most of the studies of obesity and postoperative outcome have looked predominantly at coronary artery bypass grafting with fewer focused on valvular disease
Baseline demographics From 1 January 2004 to 31 December 2018, a total of 4780 consecutive patients who underwent aortic valve replacement were stratified by body mass index (BMI) into five categories: underweight (BMI < 20, n = 108, 2.3%), normal weight (BMI 20–24.9, n = 972, 20.3%), overweight (BMI = 25– 29.9, n = 1721, 36.0%), obese (BMI = 30–34.9, n = 1199, 25.1%), and morbidly obese (BMI > 35, n = 780, 16.3%)
We found no evidence of significant differences in survival across the BMI groups in the severe aortic insufficiency population
Summary
Most of the studies of obesity and postoperative outcome have looked predominantly at coronary artery bypass grafting with fewer focused on valvular disease. The purpose of this study was to compare the outcomes of patients undergoing aortic valve replacement stratified by body mass index (BMI, kg/m^2). Obesity rates in cardiac surgery are increasing and outcomes research within this population have led to the discovery of “the obesity paradox” [1]. Obesity should be associated with an increased operative risk in cardiac surgery and is often perceived that way [4, 5]; that is not what research suggests and obesity may be protective [1, 6]. The counterintuitive finding of reduced mortality in obese patients post cardiac surgery is known as the obesity paradox. Previous studies focused predominantly on BMI in relation to coronary
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