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The effects of body mass index on outcomes for patients undergoing surgical aortic valve replacement
Keir Forgie1,2, Sabin J Bozso1,2, Yongzhe Hong1,2
1Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Insights
This study found that underweight patients (BMI < 20) undergoing aortic valve replacement (AVR) had increased mortality risk. However, overweight and obese patients had similar outcomes to normal weight patients, suggesting they are suitable for AVR.
Area of Science:
- Cardiovascular Surgery
- Obesity Research
- Patient Outcomes
Background:
- Obesity's impact on surgical outcomes is well-studied for coronary artery bypass grafting.
- Fewer studies have focused on the effects of obesity on outcomes for valvular heart disease surgery.
Purpose of the Study:
- To compare postoperative outcomes of patients undergoing aortic valve replacement (AVR).
- To stratify AVR patient outcomes based on body mass index (BMI).
Main Methods:
- Utilized data from 4780 aortic valve replacements in Alberta, Canada (2004-2018).
- Stratified patients into five BMI groups: <20, 20-24.9, 25-29.9, 30-34.9, and >=35.
- Employed log-rank test and Cox regression for survival analysis.
Main Results:
- No significant differences in intra-operative clamp or pump times across BMI groups.
- Significant differences observed in hemorrhage, septic infection, and deep sternal infection rates (p < 0.05).
- Underweight patients (BMI < 20) showed a higher hazard ratio for all-cause mortality (1.519) compared to normal weight patients.
Conclusions:
- Overweight and obese patients are suitable candidates for aortic valve replacement.
- BMI stratification is crucial for understanding specific risks in AVR patients, particularly for underweight individuals.
Background:
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).
Methods:
The 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.
Results:
Intra-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.
Conclusion:
Overweight and obese patients should be considered as readily for AVR as normal BMI patients.
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